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How is Limb Lengthening Surgery Performed?

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How is Limb Lengthening Surgery Performed?

Every surgical operation decision, including for aesthetic purposes, is an important step. For this reason, the patient should have knowledge of the surgical techniques to be applied, the general procedure, and pre- and post-operative processes. Limb lengthening surgery takes about 1.5-3 hours. Lengthening is achieved by the body’s capacity to create new bone tissue on its own. Bone tissue, soft tissues, ligaments, blood vessels and nerves surrounding the bone adapt to this formation. It is not necessary to take bone tissue from another part of the body or another operation for soft tissues. In general, the process includes the surgically cutting the bone that is planned to be lengthened and gradually separating the two parts of the cut bone from each other with different methods. After the lengthening is completed, the bone repairs itself until it can bear the body weight again and forms the new bone tissue.


First, the bone to be lengthened is cut, this process is called osteotomy. The leg is fixed with external or internal fixation methods. External fixation is usually applied with ring-shaped apparatus fixed from the outside of the leg. In the internal fixation method there are nail-like implants placed inside the bone. The next process have two stages;

1. Distraction Phase:

The bone region divided into two part by the cutting process (osteotomy region) is gradually and continuously separated from each other along the axis (distraction osteogenesis). Total lengthening of 1 mm per day is achieved at intervals. A total bone lengthening of 1 mm is achieved per day. Between the two parts of the bone, new bone is formed from the body’s own tissue. At the beginning of this stage, patients usually start walking with the help of crutches.


2. Consolidation Phase:

The second stage is the recovery and consolidation phase. When the distraction phase is completed, the bone tissue starts solidifying. Soft tissue surrounding the bone also lengthens to the same extent. At this stage, the patient gradually begins to put more weight on the limb and walks without crutches.

Scientific Perspective

In the late stage of bone lengthining ; interleukins are released and act with growth factors, leading to the attraction, proliferation and differentiation of mesenchymal stem cells into osteoblasts and other differentiated mesenchymal cells. Thus, matrix, collagen fibers and growth factors are produced. Once fixation is achieved, distraction triggers intramembranous bone formation. During consolidation, the high concentration of anabolic growth factors in regeneration decreases over time as bone is formed. Systemic diseases, congenital bone deficiencies, drugs and substance use can often negatively affect the quality and quantity of regenerated bone.

Recovery After Limb Lengthening Surgery

The lengthening process is started 1 week-10 days after the leg lengthening surgery. Thus, blood vessels and soft tissue of the bone in the osteotomy area, and surgical wounds are allowed to heal. At this stage, patient is allowed to walk using a walker. New bone formation and progress are followed with doctor controls and x-rays.  For average of 7-8 cm leg lengthening, approximately 4 months may be required for the complete healing and consolidation of the newly formed bone.


At this stage, the patient should start walking using only a cane or without any assistive device. Now the patient begins to return to his practical life. Physiotherapy and doctor controls are important for the bone and surrounding tissue to adapt to the new formation and to improve mobility. It is possible to say that approximately 1 month of healing time is required for every 2 cm lengthening.


Limb lengthening surgeries may have potential complications. Infection may occur in the pin and wire areas of the apparatus used, incision areas or in the bone. Early diagnosis and precautions with patient follow-up can prevent this risk. Edema formation can be observed, however, this is usually a temporary complication. Most scars usually disappear over time and do not cause any problems. There is a risk of damage to the the nerves and blood vessels, however, this is a very rare complication. A possible nerve injury may result in temporary or permanent loss of sensation or movement.


Another surgical operation aids recovery. Injured blood vessels can cause blood loss, depending on how severe the injury is, but it is very rare complication. Blood clot formation in a vein of the leg is called deep vein thrombosis (DVT). These blot clots may appear in the first few days after limb lengthening surgery. If the clot reaches to the lungs, it can cause serious problems with breathing. Less than 1% of patients experience DVT. Regional pain syndrome occurs when the nerves become overactive after surgery. Common symptoms include pain, swelling, stiffness and sensitivity to touch. Treatment is usually with pain medication and physiotherapy.

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