Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: Uppland on April 20, 2015, 10:44:11 PM
-
Yes, LL patients die in all countries, even if you don't want to believe it. LL is a dangerous surgery. However, no patient of Dr. Monegal has died in february. You're referring to a patient of another doctor, and that's unfair.
So apparently this surgery can be fatal, obviously this is very worrying and yet something that we rarely speak of. So I'd like to make this thread the forum for our death discussions
-How likely is it?
-Are you aware of a patient who has died?
-How can the risks be minimized?
-Is the surgery worth risking our lifes over?
-
I don't know of any stats, but I did come across a report where Dr Catagni reported a patient death during an Achilles tendon lengthening.
-
I don't know of any stats, but I did come across a report where Dr Catagni reported a patient death during an Achilles tendon lengthening.
why do you think this patient death? i readed the report, but cant remember
-
why do you think this patient death? i readed the report, but cant remember. it was fat embolism?
Yep.
[Strategy in the surgical treatment of achondroplasia: techniques applied in the Department of Orthopedics and Traumatology Hospital of Lecco]
M.A. Catagni, F. Guerreschi, L. Lovisetti
Between 1982 and 2007, 128 patients with achondroplasia were treated in the Lecco Hospital. 100 of these were treated with sequential bilateral limb lengthening and seven with crossed lengthening. The average tibial lengthening was 14.1 centimeters (range: 6 to 19 cm). The average femoral lengthening was 9.8 centimeters (range: 8 to 12 cm), and the average humeral lengthening 8.3 centimeters (range: 8 to 12 cm).
...
The complications were classified as minor, moderate, and severe. Minor complications were those which required only modification of the apparatus during treatment. Twenty-three percent of the lengthenings required some modification of the device during treatment. Moderate complications were those which required additional procedures during lengthening. Forty-two percent of patients fell into this category. Finally, severe complications were those which required another surgery following treatment or had lasting sequelae of the treatment. Twenty-one percent of patients fell into this category. The most common complication was equinus contractures of the ankle which required treatment by tendoachilles lengthening. Two pulmonary emboli were sustained following percutaneous tendo-achilles lengthening. One patient died as a result of this complication.
http://link.springer.com/article/10.1007%2Fs10261-009-0032-9
[Fat embolism during limb lengthening with a centromedullary nail: three cases].
Blondel B1, Violas P, Launay F, Sales de Gauzy J, Kohler R, Jouve JL, Bollini G.
Several methods are available for progressive limb lengthening, including centromedullary nailing, external fixation, or a combination. Each technique has its own advantages and drawbacks. In trauma victims, use of centromedullary nailing is associated with potentially fatal fat embolism. This fatal outcome might also occur during limb lengthening, particularly in bilateral procedures. To our knowledge, fat embolism has not been reported with the use of centromedullary nail for limb lengthening. This was a multicentric study of three cases of fat embolism, including one fatal outcome. In all, 36 centromedullary lengthening nails were inserted in the three centers before these acute episodes. The first two cases occurred during single-phase bilateral procedures, the third during unilateral lengthening.
Fat embolism could result from several factors, as reported in the literature. While the bilateral nature of the procedure has been incriminated, the observation of an embolism during a unilateral procedure suggests other factors may be involved. Considerable increase in endomedullary pressure during reaming and insertion of the nail has been demonstrated. At the same time, there is the question as to whether the reduction of the diminution of medullary pressure by corticotomy would be an efficient way of reducing the risk of fat embolism. Based on the analysis of our three cases, we suggest that the best way to avoid fat embolism might be to drill several holes within the area of the osteotomy before reaming, in order to reduce endomedullary pressure. This can be achieved via a short skin incision, sparing the periosteum before low energy osteotomy. Since applying this protocol, the three centers have implanted 17 lengthening nails, without a single case of fat embolism.
http://www.ncbi.nlm.nih.gov/pubmed/18774027
-
Yes, of course. This surgery can be fatal, but it's very rare.
Here you've my answers:
1) very, very rare (sorry, but I don't know the exact percentage)
2) yes, I'm aware of some people who have died
3) choose a good surgeon who operates in a good clinic and follows careful protocols
4) it depends on your personal case
Could you tell us a bit more about the deaths, was there anything foreboding it or did it come out of the blue?
-
Thanks guys for starting That thread as this is a very important Point,
I have warned patients about life risk condition due to fat embolism syndrome when performing bilaterals. Some users Just replied and misscredited my arguments.
I have never had such a terrible experience myself, But this can happen to The most experienced, respected and skiLL Forumull doctors in LL.
In some cases like in Achondroplasya there migth be other health issues but short stature such as heart malformation that can end up in heart failure during anaesthetic induction.
You can probably find in the literature some statistics of such unlikely complications.
We always discuss at meetings that we must stay safe But There are some factors we cannot control. So It is better to prevent this as much as we can.
To prevent FES i normally perform drilling of the osteotomy line prior to the canal reaming to reduce intramedullary preasure and to create some escape of the fat drops out of the canal. I Also Try to ream as smoothly as I can.
One of the points that created more controversy in my thread..most of US do not recommend bilateral Femur as reaming of both bones at the same time may be risky. So I do recommend 2-stage and patients normally can deal with it quite easily.
I hope that infO is helpfull to you guys
-
Thanks guys for starting That thread as this is a very important Point,
I have warned patients about life risk condition due to fat embolism syndrome when performing bilaterals. Some users Just replied and misscredited my arguments.
I have never had such a terrible experience myself, But this can happen to The most experienced, respected and skiLL Forumull doctors in LL.
In some cases like in Achondroplasya there migth be other health issues but short stature such as heart malformation that can end up in heart failure during anaesthetic induction.
You can probably find in the literature some statistics of such unlikely complications.
We always discuss at meetings that we must stay safe But There are some factors we cannot control. So It is better to prevent this as much as we can.
To prevent FES i normally perform drilling of the osteotomy line prior to the canal reaming to reduce intramedullary preasure and to create some escape of the fat drops out of the canal. I Also Try to ream as smoothly as I can.
One of the points that created more controversy in my thread..most of US do not recommend bilateral Femur as reaming of both bones at the same time may be risky. So I do recommend 2-stage and patients normally can deal with it quite easily.
I hope that infO is helpfull to you guys
Yes, it is thank you and, I must say, it's always good to have a professional on the forum.
-
Big d did post about a near death encounter with a fat embolism.
Like anything in life there are risks, but it is quite low.
-
what about other issues like paralysis? Is it possible?
-
I shouldn't be too worried about death. There is a chance you could die just by walking to your local shops and back
-
yeah fk death.. and if it happens? you are sedated anyway during the surgery win+win you got a free ticket from this hell reality.
-
Mmm, I have never met anyone who has died from this procedure.
LOL I hope not! It would either mean that you were dead and in an afterlife yourself, or that they came back to this world from the other side. Spooky!
-
Does anyone know when fat embolism occurs? Can it happen all the way through the LL? Or only a few hours after the surgery?
-
Fat embolism syndrome can occur in immediate conjunction with a precipitating factor (trauma, surgery...) or it can be delayed for up to 3 days, although 85% of cases are apparent within 48 hours
So you mean that after 3 days and I'm still fine, I don't need to worry about fat embolism anymore?
-
Thank you for your answer Musicmaker ;) Maybe before my LL I must write a letter to my family if I die...
-
Big d did post about a near death encounter with a fat embolism.
Like anything in life there are risks, but it is quite low.
I'm interested about BigD, where can I find this post?
I'm very worried about some LL patients' deaths recently happened.
-
dEath can happen. SOme doctors underplay risks like this, but death can happen unfortunately
-
Death is very unlikely from cosmetic ll. This is, of course, a different situation for trauma ll cases and the such.
-
Death is very unlikely from cosmetic ll. This is, of course, a different situation for trauma ll cases and the such.
You start as a cosmetic patient but then you become a medical case. It can be a very slow death, taking years and several surgeries.
-
I think losings ones legs would be a more common occurrence than death.
but I have yet to see one case of anyone losing their legs due to cosmetic LL.
-
I think losings ones legs would be a more common occurrence than death.
but I have yet to see one case of anyone losing their legs due to cosmetic LL.
Exactly,
Plus, things like your patients dying would be pretty hard for doctors to hide in places like Western Europe and the United States.
-
Exactly,
Plus, things like your patients dying would be pretty hard for doctors to hide in places like Western Europe and the United States.
How would you find out about it?
-
How would you find out about it?
It would be in the papers, there is a scandal going on in Stockholm right now about a malpracticing surgeon.
-
.... There is a risk with any surgery.. But LL surgery is quite safe if done in with an experience Doctor.. Anyway...Patient care is one of the major factors in surgery. Panda
-
I'm interested about BigD, where can I find this post?
I'm very worried about some LL patients' deaths recently happened.
Don't worry angel panda will hold your hand :-) .. Panda
-
It would be in the papers, there is a scandal going on in Stockholm right now about a malpracticing surgeon.
That's the exception. Normally when people die it's not in the papers. And doctors protect each other.Didn't you know that? There are many malpracticing surgeons but only few scandals.
-
That's the exception. Normally when people die it's not in the papers. And doctors protect each other.Didn't you know that? There are many malpracticing surgeons but only few scandals.
Well then investigate your doctor thouroughly, is anyone aware of any of Guichet's paients that have suffered death?
His website claims there are none, and I am inclined to believe.
-
Well then investigate your doctor thouroughly, is anyone aware of any of Guichet's paients that have suffered death?
His website claims there are none, and I am inclined to believe.
I was talking in general. Guichet seems to be ok. He doesn't take on too many patients and is the inventor of his lengthening device. Also he is open about the statistics of his complication cases. But that's an exception. Normally doctors don't give exact statistics.
-
Dr. Guichet also seems to preserve the mechanical alignment of his patients' femurs, but it's not completely clear how he accomplishes this, since he hasn't explicitly admitted to using the reverse planning method or anything comparable. He has published a paper stating that mechanical axis remained correct in his cosmetic patients. And, unlike fitbone, Dr. Guichet's nail gives the option of full weight bearing. It's probably the strongest lengthening nail currently on the market. I'd say Dr. Guichet produces the best results based on what I've seen, but he does have a price to match the quality of these results.
-
That's the exception. Normally when people die it's not in the papers. And doctors protect each other.Didn't you know that? There are many malpracticing surgeons but only few scandals.
I've already published a post about the case of Claudia, a girl who did lengthening by the team of Dr Ginebreda in Barcelona, who died. Terrible scandal in Spain. Newspapers, TV... Something terrible occured. When a second authopsia was required to find out the cause of her death, her organs had disappeared. So disgusting!
https://www.facebook.com/pages/Justicia-para-claudia/452811688217408
-
Also than being short.
-
Death appears to be very rare. I've heard of one or two cases.
If you're worried, go to the best doctors, don't do your surgery in a third-world country, and you should be fine.
That said if you're worried about such a remote possibility, you're probably not ready for LL. For most actual LL patients, death is not even an afterthought.
-
I'm a bigger fan in looking at the doctor in question rather than the country. There's great doctors in third world countries and ty ones in first world ones.