If cost and time isn't an issue then weight bearing > unilateral > non weight bearing bilateral imo
I don't see myself in wheelchair for months not even 1 week due to my house having stairs everywhere.
Quote from: RealLostSoul on December 07, 2022, 10:09:41 PMI was thinking about 4 surgeries so every leg segment at a time would be a bad idea. Or if you only want femurs or only want tibias I wouldn‘t do it in 2 surgeries. But if you want quadri like you did you need 2 surgeries anyways.
Hope you understand what I mean.
Yes, I understand the point you are making. To anybody considering quadrialteral lengthening, I would recommend staged/ unilateral lengthening, since you can do one lateral side (tibia + femur) in one surgery and do the other lateral side 5-6 months later.
Quote from: challengeaccepted on December 08, 2022, 03:54:38 PMI don't see myself in wheelchair for months not even 1 week due to my house having stairs everywhere.
This is a very good point. I myself live in an apartment building with multiple floors of staircase to climb, in order to leave and enter my apartment. Bilateral Precice would NOT have been an option for me, as this would have meant, I could not leave my home for half a year.
Quote from: ten on December 08, 2022, 03:45:21 AM- Staged LL is recommended by many good surgeons for medical safety. People have died doing bilateral LL..
First,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments
Quote from: RealLostSoul on December 08, 2022, 08:09:08 PMFirst,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments
First, Peter Thaller. Even Assayag thinks it's a great idea to do staged.
Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.
Quote from: ten on December 09, 2022, 02:51:35 AMFirst, Peter Thaller. Even Assayag thinks it's a great idea to do staged.
Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.
Send me a source please (eg cyborg4lifeinterview) because I can‘t believe that they think it‘s a good idea for cosmetic lengthening.
Yes. The one segment at a time. Like left femur then right is what I think is ridiculously bad. The only benefit is you have a less chance of fat emboli syndrome, a shorter anesthesia and you can limp around on one leg (again I think that this is not really beneficial, you won‘t be living normal like that AND especially if you can just use a weightbearing nail).
But the downsides are a lot and very many significant ones.
Sorry but if you use a bit of common sense you see it‘s not a good option.
Quote from: ten on December 09, 2022, 02:51:35 AMFirst, Peter Thaller. Even Assayag thinks it's a great idea to do staged. Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.
I can confirm Peter Thaller and Dr.Koehne exclusively do staged lengthening with precise 2 patients, as I have talked to them personally. They also do not manage their own clinic for ll patients, such as Paley or Assayag, to accomodate wheelchair patients for an extended period of time. Which is why treating a wheelchair patients is highly inconvenient for them and the patients themselves.
The reason why they do it, is for safety reasons primarily. The chance of breaking a partially weight-bearing nail with a bilateral patient is significantly higher than with a staged ll patient.
Quote from: RealLostSoul on December 09, 2022, 02:42:41 PM(again I think that this is not really beneficial, you won‘t be living normal like that AND especially if you can just use a weightbearing nail).
The logic here is not very consistent. You are saying a staged ll patient wont live a normal life with, but a bilateral wheelchair patient will?
Again there are pros and cons for both and it also depends on each and everyones OWN personal situation. For example, I would not have been able to have done it bilaterally, as living in a wheelchair would not have been possible for me, for any time period for various reasons.
So completely dismissing it, as you are doing, is simply not correct.
Quote from: Siegfried on December 09, 2022, 08:00:53 PMI can confirm Peter Thaller and Dr.Koehne exclusively do staged lengthening with precise 2 patients, as I have talked to them personally. They also do not manage their own clinic for ll patients, such as Paley or Assayag, to accomodate wheelchair patients for an extended period of time. Which is why treating a wheelchair patients is highly inconvenient for them and the patients themselves.
The reason why they do it, is for safety reasons primarily. The chance of breaking a partially weight-bearing nail with a bilateral patient is significantly higher than with a staged ll patient.
That does make somewhat sense. I didn’t consider that they don‘t have a rehab for these patients. I still would never do this, probably would be the lowest of all my choices (if you put aside externals in turkey and india of course)
i rather do weightbearing or at least where I can lengthen bilateral (at a rehab). Tbh rn I could not think of doing LL without weight bearing. I think I would have quit a long time ago with precice.
Quote from: Siegfried on December 09, 2022, 08:00:53 PM
The logic here is not very consistent. You are saying a staged ll patient wont live a normal life with, but a bilateral wheelchair patient will?
Again there are pros and cons for both and it also depends on each and everyones OWN personal situation. For example, I would not have been able to have done it bilaterally, as living in a wheelchair would not have been possible for me, for any time period for various reasons.
So completely dismissing it, as you are doing, is simply not correct.
No the logic is; you are indicating that you can live a normal life if you limp on one leg but I am saying that‘s not the case. So if both are hindering you, I don‘t see it as a big benefit over the other.
I would still completely dismiss it man. I do see the point though. Yes maybe in some cases where you can only go to these doctors and this is better for you, then maybe it has some value but if I am honest I would rather save up more money and do it either nonweightbearing at a great center like Paley or even better weightbearing.
Quote from: RealLostSoul on December 08, 2022, 08:09:08 PMFirst,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments
Monegal also did 1 segment at a time. But I don't know what happened with him as was many years out of the LL world. Last time I remembered some butchered cases with him, especially a girl that had a diary (quitargirl was her nickname if I remember right).
Generally speaking, doing different surgeries for each leg (not necessarily wait to finish lengthening to the one leg to do surgery on the other but even waiting 2-3 weeks between surgeries of each leg) are safer in terms of embolism, the most life threatening risk of LL.
But due to more money (2 surgeries cost more than one of.course) needed, most patients prefer to just do one surgery with both feet at once. But it is not safer than doing 2 surgeries, each for every foot.
Quote from: Body Builder on December 10, 2022, 12:50:03 AMMonegal also did 1 segment at a time. But I don't know what happened with him as was many years out of the LL world. Last time I remembered some butchered cases with him, especially a girl that had a diary (quitargirl was her nickname if I remember right).
Generally speaking, doing different surgeries for each leg (not necessarily wait to finish lengthening to the one leg to do surgery on the other but even waiting 2-3 weeks between surgeries of each leg) are safer in terms of embolism, the most life threatening risk of LL.
But due to more money (2 surgeries cost more than one of.course) needed, most patients prefer to just do one surgery with both feet at once. But it is not safer than doing 2 surgeries, each for every foot.
Yes of course that is why with quadri they do tibias first then femur after 2-3 weeks. To not ream 4 segments in one go as that has a high risk of fat emboli syndrome because more fat droplets would accumulate in the circulation. That‘s what I said. And yes unilateral is theoretical even safer than bilateral.
What we are talking about here is doing an entire lengthening process but only one segment, then after a year or so do the other segment and go over it again. I think it‘s a terribly awful idea. Lengthening into a huge discrepancy and waiting a long time to fix it by going over same process again. It‘s not about avoiding a lengthier surgery and fat emboli and thus do it weeks apart. It‘s lengthening into a huge discrepancy that is fixed 1 year later
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