Q&A With Dr Jean-Marc Guichet

Dr Jean-Marc Guichet has registered with LL Forum. If you have any questions for Dr Guichet about limb lengthening, this is the thread to ask.

Here is the link to his thread in the Doctor Directory: http://www.limblengtheningforum.com/index.php?topic=2400.0

Hello KiloKahn,

My apologies if this has already been covered, but what steps does this forum take to confirm the identities of the doctors participating here?

Quote from: CCMidwest on March 21, 2016, 06:44:39 PMHello KiloKahn,

My apologies if this has already been covered, but what steps does this forum take to confirm the identities of the doctors participating here?

We contact their official e-mail with a formal invite. Dr Guichet replied that he has registered and has made a post: http://www.limblengtheningforum.com/index.php?topic=3314.msg50649#msg50649

Quote from: KiloKAHN on March 21, 2016, 06:51:07 PMWe contact their official e-mail with a formal invite. Dr Guichet replied that he has registered and has made a post: http://www.limblengtheningforum.com/index.php?topic=3314.msg50649#msg50649

Thanks Kilo

Firstly, thank you Dr Guichet for registering to this forum. You are certainly a Dr that myself, and I'm sure others, will be very interested to hear from.

I noticed from reading your website that part of the initial preoperative tests you have a dental consultation. As someone who has an irrational fear of dentists (yet quite willingly would break bones!), what is the reason for this?

Other doctors have suggested that the muscular strength of leg muscles is not important as this can lead to resistance when lengthening. From what I understand this is contrary to your view. Is this a view you hold within respect to your nail, or is it for any lengthening method? If for the later, would you mind expanding on your reasons?

In regards to your Hyper Fast-Track recovery approach, how much do you credit this to the pre-operative fitness levels of your patients, and how much do you attribute to weight bearing and physiotherapy post surgery? In your view, if another method was used that was not fully weight-bearing - e.g. fitbone or precise - would having a unilateral procedure see a better recovery as a level of mobility and movement would be retained.

Quote from: Nightwish on March 21, 2016, 10:19:23 PMI noticed from reading your website that part of the initial preoperative tests you have a dental consultation. As someone who has an irrational fear of dentists (yet quite willingly would break bones!), what is the reason for this?

I was also very curious about this dental consultation.....how does it relate to LL?
Thanks.

The question i wish to ask is how much in total?

i know the set rate for operation is 65000 euros and 50 000 pounds but what are the estimate in total
if we require housing and food ?
i reckon somewhere between 75000 euros range? +/- ?

Quote from: ouroboros on March 25, 2016, 03:51:04 AMI was also very curious about this dental consultation.....how does it relate to LL?
Thanks.

When I had surgery for my femurs (with another doc), the anesthesiologist also asked me if any teeth were loose. Not sure if they're looking for the same issues but here's what I found online:

QuoteWhen you are being intubated, the teeth are very close and there is always a possibility of a tooth being chipped or damaged, particularly if a tooth is capped or loose. By giving any details of loose or capped teeth, the anesthesiologist can make extra sure to prevent damaged teeth. Sometimes, if a tooth is really loose, it is wise just to take it out before your surgery.

The reason for the dentist is almost certainly because there is a theoretical small risk of bacteremia (spread of bacteria through the blood) from uncontrolled periodontal gum disease, which increases the risk of orthopedic surgery site infections post-operatively. Good dental care before surgery decreases the risk of prosthesis/bone infection, and it's good for everyone anyway, so it is a small potential benefit, and no risk requirement to implement. Even if it prevents just one case of osteomyelitis it will have been worth it.


Dr. Guichet, I have an enormous amount of respect for your nail design and surgical outcomes. I am wondering:

1) What you think of the Reverse Planning Method as described by Dr. Baumgart in 2009 for correcting and maintaining ideal axis during lengthening?

2) What steps specifically do you take during your surgeries to maintain good control over the axis of lengthening and the exact angulation/orientation of the proximal distal bone fragments after osteotomy but before fixation of the nail?

Thanks.

For dental consultation, it is related to risk of infection (bacteriemia).

For muscle strengthening, it is important. Isokinetic muscle testing (Biodex, Cybex, et.) show alterations of the muscle during lengthening and slow recovery if you do not act preventively. Of course, not doing muscle testing prevents knowing the effect of a lengthening on a muscle... When you do not do, you do not know! During lengthening there is a loss of 60-80% of the initial strength. Of course, if before surgery you increase by 50%, you loose less and recover faster. It is easier to gain muscle force on a normal healthy muscle than on a healing muscle (when a sports professional has an injury on the muscle, no strengthening is authorized; during lengthening, muscle cells are dividing like during natural growth) and a trained muscle keeps memory of the training and recovers faster.

The second reason for muscle training is the adaptation of the muscle: if you train before surgery, the muscle divide and learn that stretching and training is good. Doing muscle biopsies shows a normal muscle formed during lengthening with no fibrotic tissue. When no training is applied, fibrotic muscle is formed, and studies with external fixates (Ilizarov) proved a certain % of fibrotic tissue formed. Overall, the logics is that when you train for anything in life (going on the top of the Himalayas, marathon, sports competitions, etc.), the results is better with less problems or complications. The training is not detrimental to the lengthening and my patients are here to prove it, and we are promoting fast recovery as you know (hyper-fast-track)