Verteporfin: Scarless healing

Edit Post

So you are saying even with an ITB release there will be a loss of flexibility, or is that only the case when ITB release is not performed?

Edit Post

Quote from: MakeMeTallAF on July 23, 2021, 03:23:59 AMSo you are saying even with an ITB release there will be a loss of flexibility, or is that only the case when ITB release is not performed?

The ITB is not "flexible." ITB release allows you to stretch effectively to regain mobility. Not performing ITB release will lead to loss of function for some people. The band will abduct your legs and make you walk like a duck or penguin.

Edit Post

Quote from: SirStretchAlot on July 23, 2021, 07:02:20 AMThe ITB is not "flexible." ITB release allows you to stretch effectively to regain mobility. Not performing ITB release will lead to loss of function for some people. The band will abduct your legs and make you walk like a duck or penguin.

This is correct.  Talking to many surgeons and physical therapists, any notion that the ITB can be “stretched” is pseudoscience.  You absolutely must release in cases of large lengthening, over 5cm for sure.  They’ve done examples with cadaver ITB bands where they hang hundreds of pounds of weights on the severed band and the band stretches only a small amount.  The ITB is not flexible, incredibly tough, and not releasing it will cause more problems than release will.

Edit Post

Quote from: SirStretchAlot on July 23, 2021, 07:02:20 AMThe ITB is not "flexible." ITB release allows you to stretch effectively to regain mobility. Not performing ITB release will lead to loss of function for some people. The band will abduct your legs and make you walk like a duck or penguin.

But my question is, even if the ITB band is released why is there a loss of flexibility in the leg? Does the growth of the ITB band not keep up with the bone, therefore leaving the ITB shorter than the rest of the tissues in that segment?

Is this permanent?

Edit Post

Quote from: MakeMeTallAF on July 23, 2021, 09:22:49 PMBut my question is, even if the ITB band is released why is there a loss of flexibility in the leg? Does the growth of the ITB band not keep up with the bone, therefore leaving the ITB shorter than the rest of the tissues in that segment?

Is this permanent?

1) You lose flexibility due to various muscle/tendon/fascae. Hip flexors and ITB are for everyone. Few also have trouble with quads and hamstrings. The ITB is just one of the tissues you need to lengthen to match your lengthened legs.

2) A release will relieve tension the ITB, allowing you to stretch other important muscle groups, instead of being stuck in an abucted position where you can't stretch at all.

3) The ITB does not "grow". The only way for it keep up with the length of your femur is if you cut it, so the gap regenerate with identical tissues. This will lead to an ITB with nearly the same length to your femur. Again, this is not from stretching, but from damage and regeneration.

4) While the band will not stretch there are muscles such as TFL and smaller muscles near the knees that will. However, these are small muscles thus their lengthening capacity is very limited. Therefore for any long lengthening (>5cm like HobbitMan said), it is strongly recommended to perform a release.

Edit Post

Ah ok gotcha. It was unclear because I thought you meant the ITB is causing the loss of flexibility so I assumed your ITB ends up shorter permanently.

If it's just muscles that cause the loss of flexibility I imagine that isn't permanent since with enough stretching eventually they will grow (due to distraction histeogenesis). Though, if any of the tissues scar during the process that could be a cause of permanent loss of flexibility.

Btw, can there ever be non-union of the ITB? How does that work?

Edit Post

Quote from: MakeMeTallAF on July 24, 2021, 06:45:19 PMAh ok gotcha. It was unclear because I thought you meant the ITB is causing the loss of flexibility so I assumed your ITB ends up shorter permanently.

If it's just muscles that cause the loss of flexibility I imagine that isn't permanent since with enough stretching eventually they will grow (due to distraction histeogenesis). Though, if any of the tissues scar during the process that could be a cause of permanent loss of flexibility.

Btw, can there ever be non-union of the ITB? How does that work?

1) Not releasing your ITB can cause loss in range of motion. There's no flexibility involved with the ITB as it's not a flexible tissue.

2) There is always a theoretical maximum tissues can stretch before they are injured. Unless you surpass that maximum by lengthening too much, there will be no "scarring." The only way scarring can occur as you described is if you stretched irresponsibly and damaged your muscle. Stretching itself does not cause scarring, it simply realigns the muscle fibers. I think you're confusing stretching with resistance training, where muscles hypertrophy occurs through damage/recovery cycles.

3) I am not aware of any non-union cases with the ITB.

Edit Post

Well resistance training doesn't cause muscle scarring either

I don't think you understand though, the muscles aren't simply stretching they are growing too: "When gradual distraction forces are applied across the osteotomy, not only the callus elongates but also the soft tissues grow in response to mechanical stress (mechanostat hypothesis). The soft tissue grows pari passu (hyperplasia occurs) and is not just merely stretched. Hence, the term is “distraction histiogenesis.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922221/

My concern was if the rate of lengthening is too fast for the soft tissues, will it scar rather than multiply? I don't really see any papers which address this.

Also do you know if there have been cases of pre consolidation of the ITB? Would they have to re-release the ITB in this case?

Edit Post

Quote from: MakeMeTallAF on July 25, 2021, 07:40:30 PMWell resistance training doesn't cause muscle scarring either

I don't think you understand though, the muscles aren't simply stretching they are growing too: "When gradual distraction forces are applied across the osteotomy, not only the callus elongates but also the soft tissues grow in response to mechanical stress (mechanostat hypothesis). The soft tissue grows pari passu (hyperplasia occurs) and is not just merely stretched. Hence, the term is “distraction histiogenesis.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922221/

My concern was if the rate of lengthening is too fast for the soft tissues, will it scar rather than multiply? I don't really see any papers which address this.

Also do you know if there have been cases of pre consolidation of the ITB? Would they have to re-release the ITB in this case?

Muscles and soft tissues don't scar with LL. Some doctors say they are regenerate and expand, some others that they are stretched, there is no clear answer to that. The only thing clear is that they are not scarring.
They only scar in the pin sites when they cut through muscles with external lengthening methods. In tibias the muscles are minimal where the pins are so the problem is negligible but in femurs, pins of monorails cut through massive muscles. Thats the main reason why externals on tibias is a disaster.

Edit Post

Quote from: MakeMeTallAF on July 25, 2021, 07:40:30 PMWell resistance training doesn't cause muscle scarring either

I don't think you understand though, the muscles aren't simply stretching they are growing too: "When gradual distraction forces are applied across the osteotomy, not only the callus elongates but also the soft tissues grow in response to mechanical stress (mechanostat hypothesis). The soft tissue grows pari passu (hyperplasia occurs) and is not just merely stretched. Hence, the term is “distraction histiogenesis.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922221/

My concern was if the rate of lengthening is too fast for the soft tissues, will it scar rather than multiply? I don't really see any papers which address this.

Also do you know if there have been cases of pre consolidation of the ITB? Would they have to re-release the ITB in this case?

1) This is what happens when you read excerpts with minimal context. He is assuming some level of normal activity when undergoing bone distraction. If you are simply stretching and not exercising, your muscles don't grow or undergo any hyperplasia. This is why limb lengthening patients experience significant muscle weakness. The muscles are elongated without hyperplasia, leading to fewer muscle cells at each cross-section. You will only recover the same level of muscle density if you undergo resistance training along with stretching.

2) I inquired about early recovery of ITB specifically with Dr Giotikas. He stated that it is very unlikely the ITB would completely heal before distraction completes.

In conclusion, if you wish to do LL with internal nails on the femur, there is very limited damage to your soft tissues long-term, except for scars on the skin. ITB release is also performed by most surgeons except for older doctors like Betz.