Things I can do to increase the chances of success on the operating table?

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So what is it about unilateral that prevents the FE?

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Quote from: Johnson1111 on May 12, 2018, 12:36:17 AMSo what is it about unilateral that prevents the FE?

50% less fat globules get reamed out of the bone canal, and subsequently your body's mechanism for dissolving these fat globules is faster/more efficient. This decreases your chances of fat globules getting dislodged in your lungs, brain or brain stem. Even by very very rare chance, fat embolism syndrome does occur in unilateral lengthening, it will also most likely have low incidence of mortality due to less fat globules that are dislodged or are in your blood stream

Look at how many unilateral deformity corrections/leg length discrepancy surgeries are done around the united states and the incidence of fat embolism syndrome and compare that to the ~2% chance from cosmetic bilateral femoral lengthening.

It should also be noted that femurs have higher chance of getting fat embolism than tibias. Dr. Paley has never seen a fat embolism syndrome from bilateral tibia lengthening. Also research papers have shown that femurs trauma has a higher incidence of FES than tibias. Bilateral internal tibias should be generally safe when it comes to fat embolism syndrome if anyone is considering that. However internal tibias can cause permanent knee pain due to the rod going through the knee joint.

Thus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

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Quote from: MirinHeight on May 12, 2018, 03:37:14 AM50% less fat globules get reamed out of the bone canal, and subsequently your body's mechanism for dissolving these fat globules is faster/more efficient. This decreases your chances of fat globules getting dislodged in your lungs, brain or brain stem. Even by very very rare chance, fat embolism syndrome does occur in unilateral lengthening, it will also most likely have low incidence of mortality due to less fat globules that are dislodged or are in your blood stream

Look at how many unilateral deformity corrections/leg length discrepancy surgeries are done around the united states and the incidence of fat embolism syndrome and compare that to the ~2% chance from cosmetic bilateral femoral lengthening.

It should also be noted that femurs have higher chance of getting fat embolism than tibias. Dr. Paley has never seen a fat embolism syndrome from bilateral tibia lengthening. Also research papers have shown that femurs trauma has a higher incidence of FES than tibias. Bilateral internal tibias should be generally safe when it comes to fat embolism syndrome if anyone is considering that. However internal tibias can cause permanent knee pain due to the rod going through the knee joint.

Thus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

MirinHeight, is it even better to have 6-month gap between unilateral surgeries than 1-month?

And are you sure that that external tibias is the safest and least invasive? Maybe less chance for FE, but what about knee pain, possible requirement of ATL, etc? Also doctors told me that in general femur is less complex than tibia. "Tibias have a risk of equinus contracture and (although small) of compartment syndrome." says Dr Franz Birkholtz

Even if external tibias is the safest, the best doctor who can give the most guaranteed outcome (aka Dr. Paley) don't perform external tibias no more.

Quote from: myloginacct on May 11, 2018, 03:43:11 PMI'm not a LL vet or a medical doctor. I'd rather just not comment on this.

E-mail Paley about your concerns, and use your own critical thinking to weigh the costs and benefits of unilateral/bilateral femur procedures with Paley/Rozbruch, given all the data and related issues we know about those.

All these doctors have their own personal interest and can be bias at times. There must be a reason why Paley doesn't encourage unilateral and not necessarily for the patients' own good. It may be dangerous to the surgery's reputation if everyone knows that bilateral isn't as safe and everyone does unilateral. And more time spent for him, he waste more time that could be spent for taking another case. Just possibility, but we don't know.

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1% possibility of major complication in LL is really not much if you consider how unvasive this surgery is with internals.
Only full externals are not so risky, anything else is. Thats why I believe that LON or LATN are truly stupid, cause you risk so much only to save 3-4 months max from your consolidation.

Anyway, embolism is not so frequent as deep infection but still both problems can be treated in the vast majority of cases, if you go to a good doctor in a good hospital and not in india or places like that.
If someone is not willing to take those risks then he should forget about LL.
After all this surgery is not for anyone, you must be really brave or crazy to do it.

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Quote from: Body Builder on May 12, 2018, 10:58:40 AM1% possibility of major complication in LL is really not much if you consider how unvasive this surgery is with internals.
Only full externals are not so risky, anything else is. Thats why I believe that LON or LATN are truly stupid, cause you risk so much only to save 3-4 months max from your consolidation.

Anyway, embolism is not so frequent as deep infection but still both problems can be treated in the vast majority of cases, if you go to a good doctor in a good hospital and not in india or places like that.
If someone is not willing to take those risks then he should forget about LL.
After all this surgery is not for anyone, you must be really brave or crazy to do it.

Risks are always there. But we can minimize it as much as possible.

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Quote from: myloginacct on May 10, 2018, 10:00:23 PMI believe you are referring to the point in the video he talks about Guichet. It's because Guichet gets his patients to muscle up before surgery. Paley essentially called that worthless.

Whether it's a positive, a negative, or even completely irrelevant how built your legs are, I can't tell. I haven't looked up any published material on this subject.

I'd like to note that if you talk to the Physical Therapists who work for Paley, they will all tell you that stretching beforehand can make a big difference.  I would highly advise it, personally.

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Quote from: FormerKidd on May 12, 2018, 02:12:13 PMI'd like to note that if you talk to the Physical Therapists who work for Paley, they will all tell you that stretching beforehand can make a big difference.  I would highly advise it, personally.

Thank you for the information.

Starting to stretch beforehand definitely seems like a good idea. The body takes some time to build flexibility. I have some personal experience with spine stretching exercises.

I was just not sure about "muscling/bulking up" thing Guichet requires of his patients. That definitely seems like it makes no difference (at best).

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Quote from: MirinHeight on May 12, 2018, 03:37:14 AMThus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

And also because increasing T/F ratio is associated with hip and knee arthritis. (If only you only lengthen the tibias.)

https://www.ncbi.nlm.nih.gov/pubmed/26398436

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Quote from: Bruce Wayne on May 12, 2018, 11:37:21 AMRisks are always there. But we can minimize it as much as possible.

Only with going to a good doctor. You cant do anything else!

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Quote from: Body Builder on May 12, 2018, 07:13:30 PMOnly with going to a good doctor. You cant do anything else!

The methods are not all equal. You said it yourself externals are safer.