Lengthening Over Nails (LON)
All-inclusive Lengthening Over Nails (LON) price
Tour Length: 1.5 Months
Procedure takes around 2 to 4 hours
The schedule of the surgery is very much dependable on the procedure adopted by for limb lengthening; e.g. as a general observation, a bilateral leg lengthening surgery with LON method takes anywhere around 2 to 4 hours; in comparison, a PRECICE lengthening surgery usually takes around 2 to 3 hours at maximum. In all methods, the surgical process can be summarized in two words: osteotomy (surgically cutting the major bone, either femur or tibia + fibula) and fixation (holding the two pieces of bone together utilizing internal or external fixator devices).
Transfers: To Hotel, Hospital and the Airport
3-Star Hotel: Receive a 3-star accommodation depending on availability
Post-Operative: Aftercare as standard within our packages
Usually, patients tend to start walking with assisted care i.e. walker or crutches, from the next day of the surgery. The primary goal, after the surgery, is to prevent any muscle rigidity and to maintain the muscle tone within normal parameters. Generally, patients are discharged, after their first rehabilitation session, a process which may last between 4 to 7 days at the hospital.
Soon after, the lengthening process can begin, either at patient’s home or here in Iran; usually at 1mm per day, until the time that the desired bone length is achieved; thus, at the rate of 1mm per day, so a 6 cm increase would take around 60 days.
Once the limb extension period has ended and the devices removed, it is time to wait for the bone consolidation period. As a general rule of thumb, for every 1 cm gained in bone height, the human body needs one month to rest and recover; so that the gaps created between the bones could fully heal, consolidate and strengthen to their prior state. Furthermore, the muscles and tendons also need to accommodate and stretch accordingly so that they adapt to the new bone growth, and flex and move with the new bone length. Generally, as per surgeon guidelines and recommendations, this consolidation period must last around 6 months, in total.
Nevertheless, it is always crucial to get a full detailed briefing with all the relevant medical information from your doctor or medical professional before and after any such procedure. The mentioned duration varies from patient to patient, depending on the amount lengthened, patient’s age, body’s ability to regenerate new bone, etc.
Escort Interpreter: Greet you and help to check in and admit
- Obtaining a visa (extra charge)
- Booking airline tickets (extra charge)
- Recreational tours (extra charge)
- VIP services (extra charge)
- Insurance and legal services (extra charge)
It is not recommended for women over the age of 45 and men over the age of 55.
External & Combined Methods (IlIZAROV, HOLYFIX & LON)
At the moment, we apply four clinical methods that have seen wide acclaim and have been adopted throughout the world as reliable and effective methods for limb lengthening. They are as follows:
- Ilizarov Method – Ilizarov’s surgical method was developed by a Soviet orthopedic surgeon, Gavriil Ilizarov and was first successfully applied in World War 2 and since has been in surgical practice, till today. It is a fully external method for bone lengthening, whereby the bone is fixated with thin wires and hoops; with an external fixator or so-called Ilizarov’s frames. Although Ilizarov’s surgical methodology seems quite direct and simple, the result may sometimes be quite frustrating, if not performed by competent hands, thereafter, and the surgical method is not applied as per the expectations of the patients. It is important to note that where, during the surgery or the post-op treatment, the medical team does not strictly comply with the principles laid down in Ilizarov’s methodology, and complications can arise, leading to gloomy outcomes for both, the patients and the medical teams involved. Regular care and maintenance of the device, its wires & screw; is crucial with this method, from the very beginning. As per the recommendations of medical practitioner’s guidance patients must strictly care and sterilize the devices, its wires, and screws, daily; usually with antiseptics such as 70% Pure Alcohol or a 10% Betadine solution, with sterile gauze. If the patient notices any indication of an infection, such as pus, redness, swelling and/or wound growth, around the device or its extensions, that they should immediately seek medical help from the surgical team who performed the surgery. The biggest problem with this method, apart from the strenuous daily regular care, is the chances of an infection, especially where sterilization is nor carried out regularly; since the wounds are open and fixated with wires; the chances of infections increase. The problem is that if an infection does happen, during the lengthening phase; the infection becomes a priority; thus, the lengthening process is often halted till the time the infection subsides.
- The “Holyfix” Methodology – This is a fully external method based on the Ilizarov technique; whereby rod-alike external metal fixators are attached to each of the legs of the patients employing pins affixed from the outside of the operated bones. During the lengthening stage, patients are required to turn screws on the device, simultaneously on both treated legs, to achieve their daily distraction of 1mm per day. Currently, this is the most economical methodology being practiced; with the only disadvantage that the patients are stuck with the devices for a period between 9 to 12 months; meaning that they have to walk, sleep and live their daily lives with the devices attached to their treated legs. The devices cannot be removed in the consolidation and strengthening stages, or until the bones fully return to their pre-surgery density and integrity and can fully bear the patient’s weight. This may test the patience of many patients and may cause them stress at the same time. But being more compact and lighter than circular Ilizarov frames, they are easier to bear and hide under wide trousers or pants. Also, the lengthening act itself is easier to perform on these monolateral devices. These are some of the advantages of why many patients prefer Holyfix to classical Ilizarov frames when considering fully external methods.
- “LON” Method (Lengthening Over Nails, a combination of internal and external fixation) – is almost practiced in similarity with the “Holy-Fix” methodology regime; i.e. it also involves the use of the same external device, but the major difference is, there are internal stabilizers implanted as well; in the shape of thin metal rods which are implanted into the bone cavity during operation. This internal nail system, with the help of external fixators, significantly reduces the time spent with external fixators. And soon after the lengthening phase is completed (usually 2-4 weeks is enough to see some hint of consolidation on x-rays) the external fixators are removed. With the earlier removal of the external fixators, the patient’s comfort level dramatically increases. The weight of the patients during the consolidation phase is being carried by the internally embedded nails, till the time that the bones have fully consolidated; soon after, these internal nails are surgically removed, with the help of a minor surgical procedure, which lasts around 30 minutes at best. This combination system has allowed quicker recovery times, in comparison to “Holyfix”; and with a better quality of life for the patients, during the recovery phases, who opt for such a limb lengthening surgical procedure.
“LON” Method patient interview
What is an Intramedullary Nail?
An Intramedullary Nail or Rod, is generally a metal rod, surgically embedded into the cavity of the bone; it has long been used to treat fractures of the longer bones in the human body. Gerhard Küntscher was accredited for its first application in 1939, to treat soldiers, returning from World War 2 with femur fractures; treatment for which, at that time, was limited to traction or plaster; both systems which required long periods of inactivity. This invention enabled the patients to return to activity within a matter of weeks, as the load of the bone is a shared with the nail, rather than just supporting the bone, as in an external fixator system.
How does this method work?
During the 1st stage of the surgery, an intramedullary nail is inserted and embedded into the bone and an external fixator device is attached to the leg from the outside. Soon after, the lengthening period begins and the intramedullary nail helps in preventing any angular deformity, during this phase. Once the lengthening phase has been completed, the external fixator can be removed with the completion of the internal fixation (screw insertion). This method was a groundbreaking development compared to the original methodology which only involved the use of an external fixator. Even today, this methodology is used worldwide by most limb lengthening surgeons.
What are the advantages of LON method?
- The greatest advantage of the LON method is that the duration of the whole process is reduced, in comparison, to the classical methods, thereby vastly increasing the comfort of the patient and achieving positive results in much shorter periods of time.
- This positive outlook, generally, reflects more positively to patient psychology due to the fact of the quick removal of the devices.
- You don’t need to use a wheelchair for the first months like with a motorized nail. Patients usually begin to walk using support from the second day.
What are the disadvantages of LON method?
- The duration of the surgical operation is longer in comparison to classical surgeries.
- Generally, prices and costs are a little higher more than classical methods, because of the usage of intramedullary nails.
How many scars would remain on my leg, after the lengthening process is complete?
It is equivalent to the conventional methods (Ilizarov or Holy-Fix) in terms of postoperative scars. While some people may find the scars disturbing, others may find them too insignificant to notice and worry about. Nevertheless, those patients who would like to get rid of scars, can easily have them erased with the help of a simple plastic surgery.
When do I return to my daily life after surgery?
You can get rid of the device in about 2 to 3 months, and overall recovery time lasts around 4 to 5 months; thereby enabling you to return to your normal life within 6 to 7 months. Most importantly, it is varied from patient to patient, as many factors determine the outcome, thus generally dependent upon the patient’s muscles, nerve structure and flexibility of their leg. Irrespectively, recovery times are significantly reduced if patients keep up with physiotherapy and continue the prescribed exercises, in a routinely fashion.
What is the maximum recommended amount of lengthening?
According to the Surgeon’s guidelines and recommendations, lengthening varies from 6 to 8 cm in a single procedure. Those who wish to grow even taller (for example, 12 to 14 cm) can achieve this by lengthening both lower and upper legs (lengthening in both the Femur and Tibia bones). The flexibility of the patient’s legs is fundamental in this lengthening process. The more flexible your legs are, the more comfortable you will be during this lengthening period.