Assoc Prof Tuluhan Yunus Emre Limb Lenghtening Surgery In Istanbul

Personal Information
Place of Birth - Date: Ankara / Turkey, 1972
Foreign Languages: English
Medical Experience
2010 - currently MEMORIAL HOSPITAL SERVICES Orthopedics and Traumatology Specialist - Istanbul / Turkey
2006 - 2010 ETIMESGUT MILITARY HOSPITAL Orthopedics and Traumatology Specialist - Istanbul / Turkey
Medical Education
2002 - 2006 GÜLHANE ACADEMY OF MILITARY MEDICAL Orthopedics and Traumatology Specialist Training - Ankara / Turkey
1990 - 1998 ERCIYES UNIVERSITY FACULTY OF MEDICINE Medical Doctor Training - Kayseri / Turkey
Other Medical Information

#Limb Lenghtening Surgery by Assoc. Prof. Tuluhan Yunus Emre#

What kind of leg lengthening surgery methods exist?
LON, Precice, STRYDE methods which are used in limb lengthening surgery.

Which method is included to your package price?
Answer is LON. LON means Lengthening Over Nail. A combination of two devices, an internal and external device. Our LON package includes

Lengthening Surgery for both legs (Femur or Tibia)
Post operative term medication
Investigation examination and tests
Hospitalization for 5 days
Hotel accomodation for 10/14 days with one person as a patient relative
10 Sessions of Physical Therapy during hotel accomodation
Transportation from airport-to airport
The total Cost is 15000 EURO


Will i have Pain during Lengthening?
Lengthening procedure will be done 4 times a day which will be equal to 1milimeters. During post operative term you have not feel pain and your body can be adaptative to lenghtening easily.

Before the treatment, with our doctor’s reccomendation, you have to have detailed blood tests


How is new bone formed?

When a bone is broken, immature bone is formed at the region of the break. This is a precursor to new bone formation and is not as hard as mature bone, but rather is moldable or pliable. Eventually, this immature bone will be replaced with bone which is hard and can bear full weight. If this immature bone is “stretched out” slowly over time before it is replaced with new bone, the bone can be made longer with new bone filling in the gap. This is how limb lengthening is done.

To lengthen a bone, the bone is cut or divided in a certain place. When the bone is cut, the two segments created can be moved apart.

What is a frame or external fixator and how does it work?

External fixation devices have been developed to control this movement. This is a hardware scaffolding outside of the body, hence “external” fixation. These devices are made of strong metal and will keep the bones stable as they undergo lengthening. The bone to be lengthened may be too small for use of newer magnetic lengthening nails that are placed inside the canal or central aspect of the bone; therefore, external fixation must be used to accomplish this goal. External fixation is built on to the arm or leg like scaffolding along the side of a building. Metal rings or bars are attached to the bones with pins or wires. Special nuts or components will be turned each day on the external fixator to create the movement of the two bone segments. A prescription will be given that tells the patient how many turns need to be made each day. As the segments move away from each other, immature bone and then new bone is formed in between the region of distraction creating length.

What is the nail for?

To shorten the time needing an external fixator, lengthening over a nail was developed. A small diameter metal nail can be placed in the center of the bone. The external fixation device’s pins and wires can be placed through the bone in strategic places around the nail that was placed in the center of the bone in such a way as to not be in contact with the nail. After the desired length of the bone has been gained, the nail is locked with screws to prevent shortening and the external fixator can be removed. The remaining nail in the bone’s canal will continue to give it stability while the newer bone created with the lengthening matures and hardens. The advantage of having the nail is that it allows the external fixator to be removed much earlier than would be the case if only an external fixator was used.

The technique “lengthening over a nail” or LON, was very helpful in the past. However, the development and release of modern, telescopic, magnetically powered lengthening nails (Precice), has made the LON technique much less necessary. It is now mostly used in countries where the Precice is unavailable.

How long does this treatment last?

After the surgery, one should expect a 3 to 4-day hospital stay. During this time in the hospital, patients and their family members will be taught how to care for the pin sites and keep them clean. Also, education will be given on how the external fixation device works and how to perform the bone lengthening by turning the components of the external fixator. The lengthening or distraction process usually starts 6-7 days after the operation.

The time it takes to lengthen the bone depends on the length difference between a person’s legs or arms. More commonly, bones can be lengthened at about 1 millimeter per day. The time it takes for the bone to harden or mature in children after the distraction is usually twice as long as it takes for the lengthening itself. In adults this may take 3 to 4 times longer. Diabetes and tobacco use are known to slow bone healing.

A rule of thumb is that it takes one month for bone to form for every centimeter (0.4 inches) of length gained. For example, if three centimeters (1.2 inches) of length or new bone are to be created, it will take about 30 days for forming the new bone, then an additional 2-3 months for healing and the bone to become hard and stable. This would be approximately four months wearing the external fixation before it could be taken off. However, expect this estimation to be shorter because the nail that is placed will give the bone stability so the external fixator may be taken off sooner, basically as soon as the lengthening has concluded (one month).


#PRECICE and STRYDE#
What are the differences between methods?
•   LON means Lengthening Over Nail. There will be 2 devices on each leg internal and external.
Advantages compare to PRECICE and STRYDE:
+ You don’t need a motorized nail. Patients usually can walk right after surgery.
+ Highly reliable and most commonly performed method in the World currently.
+ Most important factor is reasonable cost compare to Precice and Stryde.
- People Who had LON Surgery needs a second surgery for removal of their external fixators and fixator nails after lengthening period. Price includes; 1 Night hospital stay, 4 Nights of hotel stay, medications&tests, airport shuttle.

•   PRECICE-2 is the last tech intramedullary motorized nail method.
Advantages compare to LON:
+ Device is internally embedded into the patient’s bone, thats why it does not cause any discomfort and significantly minimizes risk of infection
+ No External Fixators. Nail it self electromagneticly motorized via remote control
+ More comfortable
+ No visible sign or device around your legs
+ 3 Months Lesser recovery time compare to LON (After lengthening period)

•   STRYDE is the upgraded version of Precice-2.
Advantages compage to LON and PRECICE 2:
+ STRYDE nails are made of stainless steel, which much stronger and durable than PRECICE 2 titanium-made nails
+ STRYDE nails can easily bear full weight of the patients so thats why after few weeks of crutch usage you will be able to walk around without any help.
+ STRYDE allows patient not to use bloodthinner which means lesser cost
+ No External Fixators. Nail it self electromagneticly motorized via remote control
+ Device is internally embedded into the patient’s bone, thats why it does not cause any discomfort and significantly minimizes risk of infection
+ 3 Months Lesser recovery time compare to LON (After lengthening period)

•   Will i have Pain during Lengthening Period?
Other than pain right after your surgery; Answer is NO! Lengthening will be done once a day which will be equal to 1milimeters. So due to it's small size, human body can easily adapts to lengthening and pain won't occur as expected.

•   Can i have both Tibia and Femur surgery at the same time?
Unfortunately no. You can not have both surgeries at the same time.

•   What are the risks associated with leg lengthening surgery?
The patient must know this, there is no 100% risk free surgery in the world. Some of the risks; Surgical, Anesthesia, Blood clot (embolism), Infection, Joint stiffness, Circulation disorders or pain due to nerve tension. These symptoms may happen in very low percentages but patient must know it before making a decision about getting this surgery. Tiny infections on the exhausts of the nails are seen in many patients and it is quite treatable without causing serious problems.

•   Who CAN NOT have Lengthening surgery?
People who has Blood Clotting Disorders, HIV/AIDS, Active Infections and BDD (Body dysmorphic disorder is a mental disorder in which you can't stop thinking about one or more perceived defects or flaws in your appearance). Also people who can not fulfill its responsibility during lengthening period.


•   What kind of leg lengthening surgery methods exist?
There are Ilizarov, Holyfix, LON, Precice, STRYDE methods which are used in limb lengthening surgery. LON is currently the most preferred method by our patients because of its short recovery time and low price.

•   How does LON Method work?
During the 1st stage of the surgery, an intramedullary nail is inserted into the bone and an external fixator device is attached to the leg from outside. During the lengthening period, the intramedullary nail prevents angular deformity. When lengthening is completed, the external fixator can be removed with the completion of the internal fixation (screw insertion). This method was a groundbreaking development compared to the original method that only involved the use of an external fixator. Even today, many limb lengthening surgeons worldwide use this method.

•   How many centimeters can I gain with leg lengthening surgery ?
For cosmetic reasons, it is preferable not to lengthen over 6-8 cm per segment. We believe that safety needs to come first. There is no point in trying to lengthen 10 cm per segment. If a patient desires to lengthen 10-14 cm, it is preferable to do 5-7 cm on tibia then 6-8 cm on femurs independently rather than to lengthen 10 cm on one section. The flexibility of your legs is also important. The more flexible your legs are, the more relaxed you will be during the lengthening.

•   Can I get back my pre-surgery health?
Although this is an operation method, it is completely a cosmetic method. Limb lengthening procedure may take some time, but eventually you can get back your pre-surgery health and do sports that you want. For many sports types, you may have to wait up to 1 year after recovery. The key is to be patient, stick to the instructions of your doctor, do your exercises and care about your overall
•   Can I get back my pre-surgery health?
Although this is an operation method, it is completely a cosmetic method. Limb lengthening procedure may take some time, but eventually you can get back your pre-surgery health and do sports that you want. For many sports types, you may have to wait up to 1 year after recovery. The key is to be patient, stick to the instructions of your doctor, do your exercises and care about your overall health.
 
•   How many scars are formated on the legs after surgery?
It is equivalent to the conventional methods in terms of postoperative scars. While some people are disturbed by the scars, others find them too little to worry about. Nevertheless, those who want can get rid of scars with the help of a plastic surgery.
 
•   When do I return to my daily life after surgery?
You will get rid of the device in 2-3 months, get well in 4-5 months, return to normal life in 6-7 months. Of course, it depends more on your muscles, nerve structure, flexibility of your leg and the exercises you must do in the process.
 
•   Can I walk with a device on my legs?
You can walk at home or get out to walk with devices on your legs. It is advisable to walk as long as it is not too extreme. At the same time, you can also do your works that you do not need much to stand up.

•   What are the difficulties of this surgery?
You will be in bed the first day. 2nd day you can use walker and do your needs. Depending on your situation you will spend 5 days at the hospital. You have to be patient for the first two months after the operation. Because every day you will be 1 mm longer. With time, there may be tension on your legs. But this is temporary. After the lengthening is over, the pain is reduced and the tension ends..
Is any kind of preparation needed before leg lengthening operation?
It is recommended to do stretching exercises, go swimming etc. in order to increase the flexibility of leg muscles. Besides physical preparation for surgery, it is equally important to prepare yourself psychologically.


LON surgery 15.000 EURO
PRECICE-2 surgery 34.000EURO
STRYDE surgery 49.000EURO

Our packages cover all the necessary things for a patient who will be operated in Istanbul.

Before the operation you have to send us AP LATERAL 2 sides X-Ray of the bones as Femur or Tibia

Before one week ago you have to send us your flight details for surgery and transportation organisation.

Payment should only be made in cash or by wire transfer to our bank account at least one week before you arrive.
You are gonna stay in Istanbul nearly 15-16 days. We also recommend you to bring a relative person to be with you.

With Limb Lengthening extensor, you will be taller 1mm a day. 10 days=1cm

If you have PRECICE-2 or STRYDE when you finish your lengthening you need to come back for control and bring back the remote control device.

We wish healthy days

Contact details;
Call or text message via WhatsApp: +905497114942

Address: Harbiye, Teşvikiye Cad. Bayer Apt. D:63, 34365 Şişli/İstanbul

http://www.tuluhanyunusemre.com/op-dr-tuluhan-yunus-emre/

What kind of leg lengthening surgery methods exist?
LON, Precice, STRYDE methods which are used in limb lengthening surgery.

Which method is included to your package price?
Answer is LON. LON means Lengthening Over Nail. A combination of two devices, an internal and external device. Our LON package includes

Lengthening Surgery for both legs (Femur or Tibia)
Post operative term medication
Investigation examination and tests
Hospitalization for 5 days
Hotel accomodation for 10/14 days with one person as a patient relative
10 Sessions of Physical Therapy during hotel accomodation
Transportation from airport-to airport
The total Cost is 15000 EURO


Will i have Pain during Lengthening?
Lengthening procedure will be done 4 times a day which will be equal to 1milimeters. During post operative term you have not feel pain and your body can be adaptative to lenghtening easily.

Before the treatment, with our doctor’s reccomendation, you have to have detailed blood tests


How is new bone formed?

When a bone is broken, immature bone is formed at the region of the break. This is a precursor to new bone formation and is not as hard as mature bone, but rather is moldable or pliable. Eventually, this immature bone will be replaced with bone which is hard and can bear full weight. If this immature bone is “stretched out” slowly over time before it is replaced with new bone, the bone can be made longer with new bone filling in the gap. This is how limb lengthening is done.

To lengthen a bone, the bone is cut or divided in a certain place. When the bone is cut, the two segments created can be moved apart.

What is a frame or external fixator and how does it work?

External fixation devices have been developed to control this movement. This is a hardware scaffolding outside of the body, hence “external” fixation. These devices are made of strong metal and will keep the bones stable as they undergo lengthening. The bone to be lengthened may be too small for use of newer magnetic lengthening nails that are placed inside the canal or central aspect of the bone; therefore, external fixation must be used to accomplish this goal. External fixation is built on to the arm or leg like scaffolding along the side of a building. Metal rings or bars are attached to the bones with pins or wires. Special nuts or components will be turned each day on the external fixator to create the movement of the two bone segments. A prescription will be given that tells the patient how many turns need to be made each day. As the segments move away from each other, immature bone and then new bone is formed in between the region of distraction creating length.

What is the nail for?

To shorten the time needing an external fixator, lengthening over a nail was developed. A small diameter metal nail can be placed in the center of the bone. The external fixation device’s pins and wires can be placed through the bone in strategic places around the nail that was placed in the center of the bone in such a way as to not be in contact with the nail. After the desired length of the bone has been gained, the nail is locked with screws to prevent shortening and the external fixator can be removed. The remaining nail in the bone’s canal will continue to give it stability while the newer bone created with the lengthening matures and hardens. The advantage of having the nail is that it allows the external fixator to be removed much earlier than would be the case if only an external fixator was used.

The technique “lengthening over a nail” or LON, was very helpful in the past. However, the development and release of modern, telescopic, magnetically powered lengthening nails (Precice), has made the LON technique much less necessary. It is now mostly used in countries where the Precice is unavailable.

How long does this treatment last?

After the surgery, one should expect a 3 to 4-day hospital stay. During this time in the hospital, patients and their family members will be taught how to care for the pin sites and keep them clean. Also, education will be given on how the external fixation device works and how to perform the bone lengthening by turning the components of the external fixator. The lengthening or distraction process usually starts 6-7 days after the operation.

The time it takes to lengthen the bone depends on the length difference between a person’s legs or arms. More commonly, bones can be lengthened at about 1 millimeter per day. The time it takes for the bone to harden or mature in children after the distraction is usually twice as long as it takes for the lengthening itself. In adults this may take 3 to 4 times longer. Diabetes and tobacco use are known to slow bone healing.

A rule of thumb is that it takes one month for bone to form for every centimeter (0.4 inches) of length gained. For example, if three centimeters (1.2 inches) of length or new bone are to be created, it will take about 30 days for forming the new bone, then an additional 2-3 months for healing and the bone to become hard and stable. This would be approximately four months wearing the external fixation before it could be taken off. However, expect this estimation to be shorter because the nail that is placed will give the bone stability so the external fixator may be taken off sooner, basically as soon as the lengthening has concluded (one month).

Contact details;
Call or text message via WhatsApp: +905497114942

Address: Harbiye, Teşvikiye Cad. Bayer Apt. D:63, 34365 Şişli/İstanbul

http://www.tuluhanyunusemre.com/op-dr-tuluhan-yunus-emre/

🍀Lengthening surgery is an orthopedic surgical procedure performed to increase the leg length due to health problems or aesthetic reasons. It is applied by using an external or internal fixator to cut the bone planned to be lengthened and to expand the space between the split ends. While the bone in the gap, which is expanded a little every day, is stretched, new bone production occurs in the opened area. Lengthening is provided by the body's own bone, soft tissues, ligaments, blood vessels and nerves that surround and support it, as well as the organism's capacity to form new bone. There is no need to take bone from any other part of the body.

🍀Lengthening is done by surgically cutting the bone and separating the cut bone pieces from each other, around 1 millimeter each day, in a long process. Thus, new bone tissue is formed in the opened space and the bone is elongated. The formation of new bone by removing the bones from each other is called distraction osteogenesis.

🍀Lengthening is done only for bones. Muscles, ligaments, nerves, vessels, and other soft tissues automatically adapt to the lengthening as they are attached to the bones and the process is done gradually. For this purpose, the process is made easier by applying physiotherapy to the relevant area.

🍀The recovery time for lengthening surgery varies from patient to patient. The consolidation process, which is the second stage of the treatment, can sometimes take quite a long time, especially in adults. As a general rule, children recover twice as fast as adult patients. For example, if the desired target new bone growth is 4 centimeters, three months would be sufficient for a child to use the fixation device, while an adult would take 6 months to complete the process.

🍀Physical therapy during recovery plays an important role in keeping the patient's joints flexible and maintaining muscle strength. Patients should eat a nutritious diet and take calcium supplements to speed up the healing process.

Hello is it possible to do LON on femur?  And how much?

Hi dear Mr. Masterson, thank you for your message and of course it is possible, could you please inform me about your height and body type then we can discuss about the details, you can write us by whatsapp +905497114942
we wish healthy days

My weight is 171 and can I be taller than 180 centimeter?

It depends on your bone condition and our doctor can evaluate your x ray, could you please send us if you have x ray result by whatsapp? +905497114942

ok thank you , I sent you WhatsApp message a few min. ago

Lengthening surgery is an orthopedic surgical procedure performed to increase leg length due to health problems or aesthetic reasons. The surgery, which can be applied not only to the legs but also to the arms, is performed by cutting the bone planned to be lengthened and using an external or internal fixator to expand the space between the split ends. While the bone in the gap, which is expanded a little every day, is stretched, new bone production occurs in the opened area. Lengthening is provided by the body's own bone, soft tissues, ligaments, blood vessels and nerves that surround and support it, as well as the organism's capacity to form new bones. There is no need to take bone from any other part of the body.

Today, cosmetic extension surgeries are a kind of cosmetic treatment option that is increasingly in high demand.
These surgeries can be divided into 3 according to the materials used and the type of procedure applied.

 Lengthening with external fixator only
Intramedullary nail application accompanying external fixator (combined technique, lengthening over nail
 Motorized nails
Motorized nails surgical technique is easy, patient comfort is also high, but motorized nails consist of systems that increase the cost.
Surgical technique is easy for extensions made with only fixators.
In the combined technique applied here, the externally worn device only stands on the leg during the extension phase, and the device is removed when the extension is over.


 Patients between the ages of 20-40 under 150 cm in women and 160 cm in men constitute the ideal patient group for cosmetic lengthening.
However, it can be applied to patients who are above these heights and who want to be taller for various reasons, if they have sufficient psychological and physical characteristics.

 The time can be calculated by adding 10 to the value in millimeters of the extension to be made. In other words, the fixator should stand outside for roughly 50 days for 40mm elongation.

 There is no pain during height growth and the patient goes through this process comfortably.
Since the lengthening procedure is performed 4 times a day, 1 mm per day, the body adapts easily and there is no pain during the extension as expected.

 During lengthening, the combined technique we apply is an extremely stable system, so walking may be difficult in the first days due to pain, and walking with pressure (full load) is allowed after surgery.

 According to the elongation obtained, the treatment period is approximately equal to the amount of elongation in months. In other words, a 6-month treatment period should be calculated for 6 cm elongation.

 The length of the neck can be planned to be approximately 5-12 cm. This amount of elongation is decided with the patient, taking into account the patient's body characteristics, targeted height, and body-leg aspect ratio.

 We receive support from our physiotherapists who are specialized in lengthening surgeries in order to walk with the help of crutches immediately after the surgery, to protect the joint movement after the extension phase, and to prevent the possibility of limitation.