LENGTHENING
Limb Lengthening Center

Limb Lengthening Center

Limb Lengthening

Dong Hoon Lee

Limb Lengthening
Center

Donghoon Advanced Limb Lengthening Reconstruction Institute has made many innovations in surgical techniques to overcome the complications of conventional lengthening methods.

Originally, bone grafts were needed in cases of insufficient bone regeneration and some patients had to live with partially healed bones. To address this problem, Dr. Donghoon Lee successfully developed a technique using BMAC (Bone Marrow Aspirate Concentrate) to enhance bone healing, and published these results for the first time. A patient can now return to normal daily activities sooner than before. In addition, Dr. Lee made technical innovations for fast and safe recovery by preventing valgus change in the LON (Lengthening Over Nail) technique and using the LATN (Lengthening And Then Nailing) method.

The first lengthening technique enhanced by successful BMAC use
(http://link.springer.com/article/10.1007%2Fs11999-014-3548-3)
Development of LON (Lengthening Over Nail) technique to prevent valgus change during lengthening
(http://link.springer.com/article/10.1007%2Fs11999-016-4712-8)
The first LATN (Lengthening And Then Nailing) Success in Korea
(http://link.springer.com/article/10.1007%2Fs11999-015-4613-20)
A 0% incidence rate of medical accidents

PRECICE Femoral Lengthening

PRECICE Femoral Lengthening -4cm

PRECICE Femoral Lengthening -6cm

PRECICE Femoral Lengthening -6cm

PRECICE Femoral Lengthening -5cm

PRECICE Femoral Lengthening -4cm

PRECICE Femoral Lengthening -5cm

PRECICE Femoral Lengthening -6cm

PRECICE Tibial Lengthening

PRECICE Tibial Lengthening -5cm

PRECICE Tibial Lengthening -5cm

LON (Lengthening Over Nail) -Tibial Lengthening

LON Tibial Lengthening -6cm

LON Tibial Lengthening -7cm

Donghoon Advanced Limb Lengthening Reconstruction Institute is a recognized world leader in limb lengthening and deformity correction.

As a limb lengthening and deformity correction field American text book author, Dr. Donghoon Lee has won multiple grand prizes (2013, 2014, 2015, 2017) in world societies such as ILLRS, LLRS, and Europe Kuntscher Society.

Why You Should Put Your Trust in Donghoon Advanced Limb Lengthening Reconstruction Institute

1Safety is our highest priority
2Our creative surgical techniques bring the best results and minimize complications
3We pursue the best results, including both functional and cosmetic
4Fast bone formation for fast recovery
5Patient-optimized surgery
6Minimally invasive technique, minimal scar
7Ideal leg alignment

Internal Lengthening

PRECICE®

Ellipse, USA

The first PRECICE surgery performed in Asia
The largest volume of PRECICE surgeries performed by a single surgeon in Asia
Minimally invasive technique, minimal scarring, simultaneous leg deformity correction with lengthening, and prevention of valgus change in the tibia
Minimized possibility of nonunion with use of BMAC (Bone Marrow Aspirate Concentrate)
0% incidence of nonunion

Internal +
External
Lengthening

Lengthening Over Nail

LON

Minimal incision and scarring
Simultaneous leg deformity correction with lengthening and prevention of valgus change
Minimized possibility of nonunion with use of BMAC (Bone Marrow Aspirate Concentrate)
0% incidence of nonunion

Lengthening and Then Nailing

LATN

Shortened recovery time (around 2 months), returning sooner to normal daily activities than original methods, and excellent bone formation
Minimal incision and scarring, simultaneous leg deformity correction is possible with lengthening, and prevention of valgus change
The first LATN (Lengthening And Then Nailing) operation performed successfully in Asia
The largest volume of LATN cases in Asia

Walking/Running after
Lengthening

Walking/Running after Lengthening

Donghoon Advanced Limb Lengthening Reconstruction Institute Interview after Lengthening Interview

Frequently Asked Question

What are the Possible Surgical Complications and What are the Chances of Experiencing Them?

We pursue the safest surgery in the world – major permanent complications (sequelae): 0%
Limb lengthening surgery has high complication rates compared to general orthopaedic surgeries. Dr. Donghoon Lee has in-depth knowledge and significant experience in this field. He has a 0% major permanent complication rate with professional operation and after-care. Preventing the problems that can occur during the lengthening period is important in limb lengthening. However, more important is the ability to solve the problems that actually occur. A surgeon should have the skills to produce the same final results, whether a patient encounters complications or not during treatment. In this respect, the patient’s choice of surgeon is very important. Generally, complications can be divided into two categories: short-term and long-term complications.

Short-term complications
Nonunion – Nonunion means permanent failure of bone healing, and in this case, additional surgical approaches are required.
Peroneal/tibial nerve injury – Temporary peroneal nerve palsy can occur, but we can prevent permanent palsy with appropriate treatment.
Blood vessel injury – Necrosis can occur when a main blood vessel is injured.
Deep infection – If there is a deep infection, additional surgery will be required to treat inflammation completely.
Malalignment – Malalignment can occur by having bones improperly aligned after lengthening. We properly align the bones with re-operation if necessary but our occurrence rate is now almost 0%.
Pin breakage – During the lengthening period, the external fixator pins can break and in this case, additional pins should be inserted.
Partial loss of sensory function around the incision – A partial loss of sensory function can occur around the incision site or in some areas of superficial sensory nerves. It cannot be 100% prevented. Many patients experience this, but it recovers well with time, and even if it does not recover fully, there is no major discomfort.
Pin site infection – This occurs quite often, but we prevent deep infection with proper management.
Anesthesia accident – Medical accident by anesthesia.

Long-term complications
Permanent disability – Compartment syndrome, nerve palsy, etc., may result in permanent disability.
Decreased sports ability – Most patients recover well (to nearly the same condition as before surgery) in terms of daily activity and light sports. However, in terms of vigorous sports, 100% recovery is more difficult. The average rate of recovery with vigorous sports activities, 2 years after surgery, is 70%.

Is it True that the Chance of Arthritis Increases or that Bones Become more Fragile after Surgery?

Patients do not have to worry about these issues if they have had proper treatment.
After lengthening, the patient’s bone is healed and remodeled. In the conventional surgical method, the bone might only partially regenerate, slowing down rehabilitation and causing the need for bone grafts in some cases. To solve this problem, Dr. Donghoon Lee developed an enhanced bone regeneration technique using BMAC (Bone Marrow Aspirate Concentrate), so we don’t worry about bone grafts as much as we did before. While future results remain to be determined, this is a significant advancement in the practice of limb lengthening. It has been published in an international journal. (http://link.springer.com/article/10.1007%2Fs11999-014-3548-3) Dr. Lee also authored a chapter of an American textbook (Limb Lengthening and Reconstruction Surgery Case Atlas: Pediatric Lower Limb Deformities: Principles and Techniques of Management). Regarding arthritis, there are many important factors to consider; such as proper leg alignment, lengthening rate control, and other factors. The patient’s choice of surgeon is the most important factor in preventing arthritis.

What is the Maximum Length Patients can Gain?

It is safe to lengthen within 20% of a patient’s original bone length.
Animal research and clinical tests show that the possibility of short-term and long-term complications is low when the gained length is less than 20% of the original bone length. Each person has different bone lengths, so recommended length depends on the person. For someone who is 160cm tall, 20% of tibia length is 6cm on average. Of course, technically we can lengthen more than that. In some cases, if a larger extent of lengthening is required, we lengthen the tibia (or femur) up to 10cm. However, in general, Dr. Donghoon Lee recommends lengthening within 20% of the original bone length, in consideration of long-term sports ability recovery and the amount of stress placed on the joint during lengthening.

Are there Specific Physical Conditions that make the Surgery Impossible?

If patients have severe medical problems, such as diabetes, osteomyelitis, HIV, or a metabolic disease that can interfere with bone formation, the possibility of surgery will be evaluated after close examination.

What is the Cost for Additional Surgery when Unexpected Complications Occur?

Each case is different. Additional surgery fees will be charged to the patient, with the exception of cases caused by our fault. However, we do our best to minimize costs when complications do occur.

Does Height Determine Whether Lengthening Surgery can be Done?

Absolute height is not an important factor for this surgery. Individual patient perception is what counts.
We do not set standards about height. The perceptions of Individual patients and self-esteem are what determine this.

How Quickly can Patients Return to Normal Daily Activities?

In the case of a 6cm tibia lengthening, patients can start to walk without crutches within 4-6 months; with LON, 3-4.5 months; with LATN, 5-6 months with PRECICE. In PRECICE femur 6cm lengthening, this takes 4 months; 1-2 months of additional rehabilitation is needed to return to normal daily activity.

How Long do Patients Require Help after the Operation?

About 2-3 days after the surgery, patients can try to stand up on their own. Normally, a week after the surgery, they can go to the bathroom by themselves. Recovery time is different from person to person, but patients will usually need a family-member, friend or care-taker to help for some period.

What Kind of Exercise do you Recommend before the Surgery?

Strengthening the quadriceps through various exercises, such as cycling, squats, lunges, walking in water, and swimming, before surgery can facilitate rehabilitation after surgery. In addition, upper body muscle strengthening exercises and stretching the entire body can be helpful.

What should patients bring for hospital stay?

We recommend that our patients bring:

Multi-vitamins
Calcium (We can prescribe it, if you don’t have it.)
Fabric, sewing material (in case you want to make an external fixator cover)
Additional pillow (helpful for positioning)
Books, movies, games, etc.
Clothes – underwear, one piece of clothing (we provide patient gowns, but you may need additional clothing when you go outside of the hospital)
Toiletries and cosmetics
Electronics – Laptops, cellphones, chargers and so on (220v)
Patients can buy a walker or crutches at the hospital.
Wet tissues, earplugs, eye patch

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