What types of lengthening procedures are available?

There are various methods of lengthening surgery. At our clinic, with innovative technology and experienced professionals, we determine the most appropriate method for the patient’s situation and perform the procedure successfully.

Ilizarov (ring or circular fixator) method:

It is considered a revolution in lengthening and deformity correction surgery.  Studies have shown that lengthening surgery using the circumferential system developed by Ilizarov has many advantages.

When correctly planned, this method can give very successful results, especially in patients with short stature and leg deformities (curvature).  However, this method is generally not suitable for surgery for “cosmetic” purposes, as the large number of wires and screws that make up the device remain in the patient’s body for a long period of time, which may cause infections and reduce the level of comfort in daily life, as well as leaving more scars on the patient’s skin when removing the existing device than with other methods.

Unilateral (straight) fixator 

In order to solve the problems encountered with the Ilizarov method, systems have been developed in recent years that are placed on one side of each leg rather than in a ring. These devices come in a variety of forms, but the basic idea is the same.

At this point, it will be noted that for people who are going to undergo surgery, the experience of the surgeon performing the procedure should be taken into account when choosing which system to use. Thus, although unilateral systems can improve comfort, they unfortunately do not provide perfect comfort for the patient because they are extracorporeal devices, such as loop fixators.

Combination system (extension system with fixer on the nail): 

This is a method that uses a combination of external and internal systems to improve patient comfort. One of the most important advantages of this method is the reduction of treatment time. For example, in a 5 cm lengthening, the external device (fixator) alone should be retained for approximately 5-8 months until osseointegration is seen.

In the combined system, this period can be shortened to approximately two months. Once the lengthening process is complete, the external fixator can be removed and skeletal development can be expected to be completed in vivo, supported by steel staples. Economically, it is more expensive than an externally-only system, but more economical than an internally-only magnetic system.

In addition, because these systems are more stable, patients are able to walk with weight on the second day after surgery. The disadvantages of this system are that the operation takes slightly longer than with external systems and the surgical technique requires experience. In this case, it is important to share previous experience with the person who chooses this method and to establish a doctor-patient relationship based on mutual “trust”. Finally, these methods carry a slightly higher risk of infection than magnetic systems applied only from within.

Electrically powered nailing method (a magnetic system is implanted into the bone and elongation is achieved by remote control): 

With the development of technology, nails have become available that do not require an external system at all and can be extended by remote control systems. The most important advantages of this method are the very small scars compared to other methods and the increased comfort of the patient. This method is especially recommended for patients who wish to return to work as soon as possible.

Postoperative pain is similar to other methods. However, since there is no device visible from the outside, the patient can move more easily and gain mobility faster than with other methods. In addition, since there are no devices touching the skin from the outside, the risk of infection is lower than with other methods. The biggest drawback to these methods, which are the most desirable methods of “cosmetic” lengthening, is that magnetic staples are expensive. However, it is believed that as technology develops, these costs will gradually decrease.

How do you decide which method to choose for lengthening?

In lengthening surgery, the amount and method of lengthening that minimises risk should be chosen based on the individual’s bone thickness, bone structure and health. When deciding which method to choose, patients should discuss with their surgeon all of the surgical methods available, the advantages and disadvantages of these methods, and which method is better for them.