Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: MirinHeight on October 09, 2017, 06:35:30 AM
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Good doctor?
I mean it would be smart to go to US doctor instead of overseas for this procedure. Becoming a doctor is hardest here and canada (DO or MD). And he got his fellowship in leg lengthening from a very good orthapedic hospital in New York. However, he does really promote the surgery.
If the money was the same, would you get the surgery in united states with Dr. Mahboubian or go to a european country/India for external ll
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Good doctor?
I mean it would be smart to go to US doctor instead of overseas for this procedure. Becoming a doctor is hardest here and canada (DO or MD). And he got his fellowship in leg lengthening from a very good orthapedic hospital in New York. However, he does really promote the surgery.
If the money was the same, would you get the surgery in united states with Dr. Mahboubian or go to a european country/India for external ll
on your first question - I don't have much info on Mahboubian what I can tell you is he is costly (less than Paley but as much as others like Guichet or Betz) and he promotes limb lengthening i a way that disrespects demean short me (see his website picture). Though I thik he is a capable doctor.
your second question is hypothetical and defies logic (how can internals in US be same as externals in India?!).
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on your first question - I don't have much info on Mahboubian what I can tell you is he is costly (less than Paley but as much as others like Guichet or Betz) and he promotes limb lengthening i a way that disrespects demean short me (see his website picture). Though I thik he is a capable doctor.
your second question is hypothetical and defies logic (how can internals in US be same as externals in India?!).
dr. Mahboubian does external ll.
i would never get internal ll done. too invasive
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The best thing about Dr. M is that you get the Taylor Spatial Frames which is freaking awesome. But honestly for the price you are better going to Dr. Pili. I feel like Dr. Pili is a better doctor. Also I will admit it is very subjective who is "better".
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dr. Mahboubian does external ll.
i would never get internal ll done. too invasive
If Paley offered you Precise nails for free, you'd say no huh.
Yeah why do invisible lengthening when you can have metal cages for legs.
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I know that amputation is a risk when going under the leg lengthening procedure.
What risks or factors lead to amputation. What is the reason the leg has to be amputated.
I'm sure it has to do with some serious infection.
And if it does, this is another reason in my opinion why external fixation> LON/LATN and precise techniques when it comes to risks.
Highly unlikely that you will develop a serious infection with external fixation (only pin site infections). But when you use intramedullary rods, you can develop some serious infections that can cause loss of limbs whereas the only infections seen with external fixators are pin site infections which are easy to catch and take care of.
Also a lot more unlikely for one to develop fat embolism when going through with the external fixation which can lead to coma/death.
I have done a lot of research on this procedure, and nailing of the long bones carries a lot more risk than the "external fixation only" approach did.
Doctors have developed this precise nail and it is a great piece of technology that has the potential for you to gain significant height, but it carries much more risk than external fixation procedures. Furthermore, doctors are getting paid a lot more for using the precise nail, so do not believe everything that they say.
My advice is to do external fixation ONLY on tibias for 5 cm or less (only go up to 5 cm for externals) first,
And if you really still don't like the height you are at, and would like to do the nailing techniques, knowing there are more and bigger risks, then do up to 5-7 cm via precise on femurs.
But I highly advise against internal-medullary reaming techniques due to the risks it carries
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Furthermore Deep vein Thrombosis that leads to pulmonary embolism and can kill you is also a big risk when doing surgery on femurs...
"Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.
Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.
A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.
PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.
Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. "
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The risks for
External fixation vs Intramedullary nailing techniques
needs to be a topic of discussion so patients can make the best safe decision for themselves. A lot of doctors are money hungry when it comes to precise and disregard many risks discussed. Dr. Paley on his site says that
"Dr. Paley has only seen fat embolism twice in his career. Both occurred more than 10 years ago before he developed a special venting method to prevent this complication."
This is a flat out lie. Dr Paley might be a phenomenal orthopedic surgeon, BUT he needs to be transparent about the risks that the precise nailing technique carries for his future patients, instead of marketing his technique as a low risk procedure.
This is from a diary from 2014:
My stay on this floor was for a long time. Too many bad things happened for me to care to recount. One good thing that stands out to me was when Servando told me I would have to pay for my extended stay in the hospital. This worried me of course, because he didn't know how much it would be and I had no idea how long I would have to stay in this s**t-hole. I emailed Dr. Paley and expressed that I was worried about the costs. Dr. Paley immediately emailed me back and told me not to worry about the costs, he would take care of them, and all he wanted was for me to recover. He gave me a private meeting in my room a few days later, also confirming this while checking up on me. Then the news was confirmed- I had gotten a fatty emboli in my lungs. For those unaware, this is when your fat being reamed out of your femoral canals goes into your bloodstream which then travels up to your lungs.
Dr. Paley in this private meeting also confirms to me that I'm only his 2nd patient ever to have a severe case of fat embolism in the past 3 years, and that I'm the worst case he's ever had of it. What an honor, huh? We talk for a few more minutes and he leaves. There's not much left to say in this meeting because my condition is improving and he's already done his job, the rest was up to me to heal.
Fat embolism might not be as rare as we think it is, and well respected surgeons might be hiding some facts about the risk of fat embolism with nailing techniques. This is just one proof.
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Cliff Notes:
I have done my own research on this topic, and made some threads/messages explaining each point I make below:
intramedullary femur lengthening risks:
- fat embolism due to intramedullary reaming
- DVT; femurs having higher risk of developing DVT than tibias
- serious infection that can lead to amputation. Only infections seen in external fixator lengthening are pin-site infections
More advantages of external lengthening:
-adjustments can be made to prevent malunion, x legs, etc
-biomechanics altered a lot more when lengthening femurs
SO YEAH, ILL RATHER WEAR A CAGE FOR 6 MONTHS THAN GO UNDER A MUCH MORE INVASIVE SURGERY. To each their own.
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Hi MirinHeight, I respect your fear for complications, but the rates for PE are really low especially for young, healthy, not obese patients like the ones who go for limb lengthening. Obviously, the decision is up to you and each one of us fights their own fears but I just wanted to say don't let fear without knowledge guide your decisions. Best wishes.
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Hi MirinHeight, I respect your fear for complications, but the rates for PE are really low especially for young, healthy, not obese patients like the ones who go for limb lengthening. Obviously, the decision is up to you and each one of us fights their own fears but I just wanted to say don't let fear without knowledge guide your decisions. Best wishes.
if one develops valgus/valus deformity during ll, it can also be fixed with external fixator. These deformities (such as x legs) cannot be fixed via internal methods.
Keeping the complications in mind, external ll is best if you want to do <5cm. If you do 6+ cm, you can do internal method keeping the complications in mind, so that you wont have to wear the external fixator for 1 year+
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if one develops valgus/valus deformity during ll, it can also be fixed with external fixator. These deformities (such as x legs) cannot be fixed via internal methods.
I think that with internal methods you don't get varus/valgus deformity in the first place. I do think externals is a valid option, no doubt.
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Problems with Traditional Internal Femur Lengthening
Internal femur lengthening devices will by their nature lengthen along the femur's anatomic axis. This can lead to shifts in the mechanical axis towards a valgus (x legs) position. Such shifts in the mechanical axis have been documented by Dr. Paley. Paley demonstrated that in normally aligned limbs, lengthening along the anatomical axis of the femur with internal Precise nails led to a lateral shift of the mechanical axis by 1 mm for each 1 cm of lengthening.
The following diagram from Paley's article demonstrates how this shift happens. Internal lengthening is compared in this picture with external lengthening, which can theoretically maintain the mechanical axis. In practice, however, we know that external monorails for femurs can lead to distortion and misalignments, as the monorail devices and pins can be subject to surgeon error and bending/warping with muscular forces and weight bearing.
(http://s22.postimg.org/e4xqtacmp/Paley_axis.jpg)
Internal lengthening of the femurs is considered an ideal method of leg lengthening for most because it is fast, safe, predictable, and effective. However, this expected shift of the mechanical axis is a concern for many of us, because any degree of varus/valgus can predispose joints to arthritis. If internal femoral lengthening is then to be considered a good method of lengthening, a solution is needed to maintain the mechanical axis in normal alignment.
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One can do internal tibias to avoid any noticeable changes in mechanical axis. However, most prospective pts opt for internal femurs. Internal tibias presents with its own risks (more complicated surgery than internal femur, possible permanent knee pain due to internal reaming at the knee, PE, etc)
Thus, external tibias 5 cm is the way to go imo.
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Cliff Notes:
I have done my own research on this topic, and made some threads/messages explaining each point I make below:
intramedullary femur lengthening risks:
- fat embolism due to intramedullary reaming
- DVT; femurs having higher risk of developing DVT than tibias
- serious infection that can lead to amputation. Only infections seen in external fixator lengthening are pin-site infections
More advantages of external lengthening:
-adjustments can be made to prevent malunion, x legs, etc
-biomechanics altered a lot more when lengthening femurs
SO YEAH, ILL RATHER WEAR A CAGE FOR 6 MONTHS THAN GO UNDER A MUCH MORE INVASIVE SURGERY. To each their own.
Who's the con artist who told you six months?
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Who's the con artist who told you six months?
only lengthening 3-3.5 cm..
of course if you lengthen 5 cm, it will be around 10 months