Q&A With Dr Mangal Parihar

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Quote from: KiloKAHN on October 27, 2015, 07:24:24 PMIn the case of femoral lengthening, a longer lengthening may be possible, because it's surrounded by muscle (unlike the tibia where there are less muscles and more tendons - comparatively speaking). Having said that, external lengthening on the femur tends to cause more problems with muscle scarring and consequent stiffness, compared to the tibia, precisely because the femur is surrounded by muscle. So what one gains in length, one may lose in terms of function. This is the primary reason why most surgeons would not do external femoral lengthening for CLL.

Internal vs External - I have no experience yet with purely internal lengthening, so I cannot say for sure. However, it's a reasonable deduction that internal lengthening in the tibia would not be much different. I would expect that internal lengthening of the tibia would have the same or similar problems beyond 6 cms, which is probably why most internal CLL is done in the femur as it allows for a greater latitude.

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Quote from: Penguinn on October 27, 2015, 08:11:57 PMDr. Parihar seems awesome but unsure on internals in femurs, which I plan on doing.
Scary.
Maybe I'm just dumb, but what does this mean?
Does he have no purely-internal tibia experience, or femur as well?

..should've asked more questions in our meeting.

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Quote from: KiloKAHN on October 28, 2015, 07:23:22 PMInternals have only recently been approved in India, so no purely internal experience would apply for both tibs and femurs. For me personally, I wouldn't be scared over that. Dr Sarin technically has more experience than Dr Parihar when it comes to internals since he uses that HLN, but I still would much rather go to Parihar than him. Plus I've seen horrible internal results from a certain other doctor who has implanted them for years, which makes me consider the doctor's degree of compassion for his patients and his proactiveness in preventing or treating complications a lot more important than how many times he's implanted a particular nail.

Because Dr Parihar has primarily treated patients for injuries, LLD and other congenital deformities, I'd think he has the advantage over a primarily cosmetic surgeon in terms of preventing complications that come with lengthening and in treating the ones that do show up - after all, Dr Paley does say that you only want to go to orthopedic surgeons who are at the top of the pyramid because of all the complications that can happen with leg lengthening. And a reconstructive surgeon with as many years of experience as Dr Parihar has likely seen it all. But if you're really nervous about it it's a good idea to talk to him again and address your concerns. Don't undergo surgery if you still have severe doubts.

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Quote from: Penguinn on October 28, 2015, 09:14:39 PMThere's no doubt in my mind that Dr. Parihar is, by far, the best doctor for LL in India. I'm just wondering how he'll be with internal femurs as opposed to other good doctors in his price range, like Dr. Monegal. I'll definitely talk to Dr. P about my concerns. If he's 100% confident he can do precice internal femurs I'll trail blaze it, but if he's not, I'll reconsider. He seems very honest from our meeting.

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Quote from: KiloKAHN on October 29, 2015, 04:40:23 PMWell based on what Thegosis wrote so far about doing his Precice lengthening with Dr Shah, it seems like Ellipse will send someone to be in the OT to be with Dr Parihar and give advice since it will be the first time the Precice would be in use at his clinic.

"Cure Surgical is the agent in India for the import and distribution for the device from the manufacture PRECICE in the USA... He's told me that a rep and product manager from PRECICE named Chris Yunker will be coming over (from the US?) specifically for me and the surgeon as it's a somewhat of a pioneering occurrence for this doctor and the Indian market to do things by means of purely internal telescopic rod...Chris was at the operation, and I heard him giving some advice about positioning the nails. It was 5 hours." http://www.limblengtheningforum.com/index.php?topic=1663.0

QuoteAre you going to set up another appointment with Dr Parihar or address your concerns by phone?

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Quote from: Penguinn on October 29, 2015, 06:46:23 PMIf you were in my place, what would you do?

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Quote from: KiloKAHN on October 29, 2015, 08:22:32 PMBased on the positive experience I had with Dr Parihar and the rest of his team, I'd go back to him for internal femurs if I decided I wanted to do them even if I were to be his first internal patient. But you have to ultimately decide if it's something you'd be comfortable with doing or if you'd rather do your operation with a doctor in Europe or the USA.

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Quote from: Average2Tall on November 15, 2015, 09:22:51 PMWhich scenario can be favorable for a solid recovery? Assuming there is no cost factor.

1. 2-3 cm Internal femur (Precice), 2 cm External Tibia

2. 4-5 cm Internal femur (Precice)