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Posted on Jan 20, 2016, 7:52 pm
#121
Quote from: TIBIKE200 on January 19, 2016, 03:12:57 PMHello dr.

  I would like to know, from your past experience, what was the safest upper limit of internal femural lengthening in centimeters that you have wintnessed? I mean how many long term complications did you encountere?

It is so individually dependent that it is very difficult to give a blanket answer. For femoral cll our max gain has been just less than 80mm without issues, but this is not the norm. Relatively safe limits on femur is around 55-65mm
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Posted on Jan 20, 2016, 7:57 pm
#122
Quote from: The View on January 19, 2016, 04:15:54 PMHi Dr Birkholtz

I want to know what you think about pre-op preparation.

How important is flexibility?

I've heard conflicting things about leg muscle/ strength.

Some say strong muscular legs are good and others say they are bad and suggest reducing muscle mass before the procedure. What is your view on this?

What would be optimal?

Would strong and flexible legs like that of a martial artist or gymnast be ideal?

Thank You

Flexibility is everything. Core strength and upper body strength is also important. Not weight lifting strength, but functional strength to be able to use your arms to assist with mobilizing (ie crutches). Great excercizes here are things like (simple?) push-ups, pull-ups, planking etc. I think pilates and yoga would be better time spent than weight lifting or building muscle bulk. Generally good physical fitness will stand you in good stead as it also gives you mental tenacity. This is a brutal process and you will need all the mental discipline and strength that you can muster.
Gymnasts and martial artists would have a great advantage. Of course I am biased as a karate practitioner ;-)
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Posted on Jan 20, 2016, 10:03 pm
#123
Quote from: Franz on January 20, 2016, 07:52:08 PMIt is so individually dependent that it is very difficult to give a blanket answer. For femoral cll our max gain has been just less than 80mm without issues, but this is not the norm. Relatively safe limits on femur is around 55-65mm

First, thank you for your answer.
  Secondly, when you say without issues, do you mean that after the process is over the people can walk normally (As if they never had an operation)?
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Posted on Jan 24, 2016, 1:04 am
#124
Dr. Birkholtz, which do you prefer LON or LATN? Is there any way to avoid the knee pain or damage, and how much time does using these nails save. Are they worth it or do you prefer straight EXFIX?
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Posted on Jan 24, 2016, 8:31 pm
#125
Quote from: TIBIKE200 on January 20, 2016, 10:03:01 PMFirst, thank you for your answer.
  Secondly, when you say without issues, do you mean that after the process is over the people can walk normally (As if they never had an operation)?
This was covered in earlier posts I believe. No amount of lengthening will leave you completely normal. There is always an effect. The longer the lengthening the more the effect. Other factors like quality of surgery, rehab as well as complications play a role. The reason why the surgeon needs to be chosen carefully.
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Posted on Jan 24, 2016, 8:35 pm
#126
Quote from: kian222 on January 24, 2016, 01:04:13 AMDr. Birkholtz, which do you prefer LON or LATN? Is there any way to avoid the knee pain or damage, and how much time does using these nails save. Are they worth it or do you prefer straight EXFIX?
It is a very individual choice. For example LON is easier if the bones are straight and LATN probably better if there is an existing deformity.
For a 5cm lengthening the exfix time for exfix only lengthening is around 7-8 months.
With LON or LATN, exfix time is around 2.5 months. Quite a difference.
Knee pain is minimized using special nailing techniques.
Bear in mind that the incidence of knee pain will also be present with the lengthening nails like Precice etc.
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Posted on Jan 27, 2016, 7:03 am
#127
Hello Dr franz

Can you tell us how to choose a doctor? The obvious criteria are what method he offers and how fluent and honest he is at explaining stuff.

Other than this we are all medical laymen who just can't tell the difference between very basic things. It becomes hard to decide especially if we don't have 150k dollars for this surgery and recovery.

Is there a set of important things to consider?

Also many docs have little cosmetic LL experience but have good correctional experience. Is this a factor to consider?

We sincerely appreciate your presence here. Than you.
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Posted on Jan 27, 2016, 9:34 pm
#128
Quote from: stanmarsh on January 27, 2016, 07:03:50 AMHello Dr franz

Can you tell us how to choose a doctor? The obvious criteria are what method he offers and how fluent and honest he is at explaining stuff.

Other than this we are all medical laymen who just can't tell the difference between very basic things. It becomes hard to decide especially if we don't have 150k dollars for this surgery and recovery.

Is there a set of important things to consider?

Also many docs have little cosmetic LL experience but have good correctional experience. Is this a factor to consider?

We sincerely appreciate your presence here. Than you.

This is a good question. Please bear in mind that my answer is not intended in any way to try and gain more patients. I have enough work as it is.

If I choose a surgeon I look for honesty, integrity, skill and the ability to form a relationship of trust. Pretty much in that order. Price should be the least important consideration. Also, do not choose a surgeon based on the technique yo want. If your limb lengthening surgeon is not comfortable performing individualised surgery (ie different types / techniques) I would look elsewhere.

Although CLL experience is reasonably important, bear in mind that generally CLL is technically a lot easier than correction of deformity, restoration of leg length discrepancy or restoration of non-unions of bone defects. I would much rather choose someone with a lot of experience in different techniques and who is comfortable preventing and managing complications in difficult cases. He or she should then be much more comfortable in performing 'simple' lengthenings.

I can not choose your surgeon, but be careful because you need to trust this person implicitly. The wrong choice can ruin your life and give you bigger problems than height dysphoria.
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Posted on Feb 1, 2016, 3:36 pm
#129
Quote from: Franz on January 27, 2016, 09:34:13 PMThis is a good question. Please bear in mind that my answer is not intended in any way to try and gain more patients. I have enough work as it is.

If I choose a surgeon I look for honesty, integrity, skill and the ability to form a relationship of trust. Pretty much in that order. Price should be the least important consideration. Also, do not choose a surgeon based on the technique yo want. If your limb lengthening surgeon is not comfortable performing individualised surgery (ie different types / techniques) I would look elsewhere.

Although CLL experience is reasonably important, bear in mind that generally CLL is technically a lot easier than correction of deformity, restoration of leg length discrepancy or restoration of non-unions of bone defects. I would much rather choose someone with a lot of experience in different techniques and who is comfortable preventing and managing complications in difficult cases. He or she should then be much more comfortable in performing 'simple' lengthenings.

I can not choose your surgeon, but be careful because you need to trust this person implicitly. The wrong choice can ruin your life and give you bigger problems than height dysphoria.

Hi Dr Franz,

I'm wanting to lengthen only 5cm, but concerned with contracture.. Would I lengthen 5.5cm to account for possible contracture or is there a way to guarentee that we can avoid bone compression altogether?
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