{Tyler-An interesting to note about distraction osteogenesis is that it strives to only do corticectomy attacking only the cortical bone this is very promising as we could potentially attack the cortical bone with less invasive methods}

If you are even remotely interested in the idea of height increase and done any research on the subject and possibilities, you probably have heard of the painful, expensive, and difficult process people talk about where a person’s legs are cut, and separated to re-heal to grow bigger. Most people know the surgical process as limb-lengthening surgery, or leg-lengthening surgery, mainly because the surgery to gain height through surgery is done on the legs, not the torso, neck, or head. Historically, the original method has been called the Ilizarov Method. Since then, new methods and techniques have developed. However, the medical name for the surgical process is called Distraction Osteogenesis.

I am not a medical professional so I will take the most important parts of the Wikipedia article on Distraction Osteogenesis found HERE.

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Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction is a surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body. A corticotomy is used to fracture the bone into two segments, and the two bone ends of the bone are gradually moved apart during the distraction phase, allowing new bone to form in the gap. When the desired or possible length is reached, a consolidation phase follows in which the bone is allowed to keep healing. Distraction osteogenesis has the benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.

….developed was the metal frame the leg was placed in to hold it perfectly in place until the cut made in the bone was healed over.

The breakthrough came with a technique introduced by Russian orthopedic surgeon Gavril Ilizarov. Ilizarov developed a procedure based on the biology of the bone and on the ability of the surrounding soft-tissues to regenerate under tension; the technique involved an external fixator, the Ilizarov apparatus, structured as a modular ring. Although the types of complications remained the same (infection, the most common complication occurring particularly along the pin tracks, pain, nerves and soft tissue irritation) the Ilizarov technique reduced the frequency and severity of the complications. The Ilizarov technique made the surgery safer, and allowed the goal of lengthening the limb to be achieved.

Using exclusively an external fixator

The most common is the Ilizarov surgery with the Ilizarov external fixator. Other external fixators are Wagner, Orthofix and Judet. Dr. Helong Bai (8th Hospital in Chongqing, China) developed the technique “Micro-wound” with a different apparatus

Ilizarov surgery

The process involves the following:

• Shattered bones and devascularised ones are removed from the patient, leaving a gap;
• The healthy part of the upper bone is broken into two segments with an external saw;
• The leg is then fitted with the Ilizarov frame that pierces through the skin, muscles, and bone;
• Screws attached to the middle bone are turned 1 millimetre (mm) per day, so that new bone tissues that are formed in the growth zone are gradually pulled apart to increase the gap (One millimetre has been found to be the optimal bone distraction rate. Lengthening too fast overstretches the soft tissues, resulting not only in pain, but also in the inability of the bone to fill up the gap; too slow, and the bone hardens before the full lengthening process is complete.);
• After the gap is closed, the patient continues to wear the frame until the new bone solidifies; the waiting period is usually 120 days before the leg can be used.

Ilizarov surgery is extremely painful, uncomfortable, infection-prone, and often causes unsightly scars. Frames used to be made of stainless steel rings weighing up to 7 kilogram (kg), but newer models are made of Carbon fiber reinforced plastic, which though lighter, are equally cumbersome.

The Guichet Method

Invented in 1987 by Dr. Jean-Marc Guichet MD, the Albizzia nail was created during his residency at the University Center (CHU) of Dijon, France. The Albizzia nail is inserted into the bone canal after it is calibrated with a reamer. The nail is then fixed to the ends of the bone fragments with screws. The nail consists of two sliding tubes that rotate in relation to the other, allowing for the nail to extend through a series of “clicks.” After insertion, the patient “clicks” the nail by turning the knee and leg (femoral nail) or foot (tibial nail) alternating inward and outward rotations to gradually lengthen. 15 clicks per day results in 1mm of gain. Expansions of up to 10 cm have been reported. The Albizzia nail is used in almost 30 countries and over 3,000 nails have been implanted.

In 2009, Dr. Guichet patented the Guichet Nail. The Guichet Nail is an improved version of the Albizzia nail because it uses stronger steel that allows for full weight bearing activity almost immediately after surgery. Furthermore, the Guichet Nail is customizable for size to ensure maximum comfort and efficiency for patients with smaller bones. Although there is initial pain after the surgery and during the clicks, the Guichet Nail is believed to be less painful than other methods as it is less invasive. Furthermore, as the patient controls the method of “clicking,” the patient is able to reduce pain by determining the most suitable method for themselves.

The Guichet Nail is currently used exclusively at the Leg Lengthening Clinic in Marseilles, France. Founded in 2011 by Guichet and Keeper, the clinic specializes in cosmetic leg lengthening surgeries. With worldwide recognition for being the foremost knowledgeable limb rescontruction surgeon with respect to internal fixators in the world, Dr. Guichet has successfully completed over 350 limb lengthening procedures.

Intramedullary skeletal kinetic distractor

In 2001, the “Intramedullary skeletal kinetic distractor” (ISKD) was introduced, allowing lengthening to take place internally, thereby drastically reducing the risk of infections and scarring. The ISKD device was designed by Dr. J. Dean Cole, MD of Orlando, Florida.

With ISKD, a telescopic rod that can be gradually extended by knee or ankle rotations is implanted into the bone. Lengthening is monitored by a hand-held external magnetic sensor that tracks the rotation of an internal magnet on a daily basis.

ISKD requires a physical leg movement to “click” the device into lengthening. In this method, there is no risk of accidentally over-stretching the bone due to the lengthener being preset to the desired fully extended length. However, there is a risk of growing the bone too quickly. Bone growth is monitored by measuring changes in the magnetic field of an embedded magnet in the system. The poles of the magnet change as the device grows. However, if the motion of the leg makes the device grow too quickly, and the magnet switches poles twice between measurements, then that growth is not recorded. This leads to overly rapid growth which can cause a number of issues such as nerve damage or causing breaks in the bone.

While there is some pain associated with the immediate post-op lengthening, the initial lengthening procedure is not to begin until one week after surgery. Furthermore, there is no noticeable “click” to the patient as there is less than nine degrees of rotation of the two bone segments in relation to one another.

Fitbone surgery

A form of surgery involving an intramedullar, fully implantable, electronically-motorised limb-lengthening implant, called “Fitbone”, is a technologically advanced, though relatively complex, device.

Developed in Germany by Augustin Betz and Rainer Baumgart, the first successful operations were performed in 1996 and the technique was patented in 1997. Thus far, most of the surgeries using this method have been performed in Munich, Germany by Baumgart and Peter Thaller. The first successful surgeries in Asia have been performed since 2001 by Dr Sarbjit Singh in Tan Tock Seng Hospital, Singapore, and Dr Sittiporn, Bumrungrad Hospital, Bangkok. In December 2005 Fitbone surgery was done in Malaysia at the Mahkota Orthopaedic Reconstruction and Limb Lengthening Center, Melaka by Thirukumaran Subramaniam and Jeyaratnam T Satkunasingam. Dr. Bruce Foster of Adelaide, Australia, chairman of the “Bone Growth Foundation” — a charity established with the aim of helping children with crippling bone growth problems — is currently the only surgeon that uses the “Fitbone” device in the southern hemisphere.

Fitbone comprises a telescopic nail implant that can extend, powered by an electric motor and controlled by a receiver with an antenna that is buried under the skin; the receiver in turn is controlled by a hand-held radio-frequency transmitter. The procedure for lengthening the lower leg is as follows:

• A two-centimetre incision is made at the patient’s knee, and a reamer is used to create enough space in the bone for a stainless steel nail.
• The bone is cut about 14 cm below the knee from the inside with an internal saw.
• The stainless steel nail is held in place by two screws. The top of the nail is attached to a tiny, plastic-encased receiver that is placed under the skin.
• The patient controls the lengthening process. By pushing a button on the transmitter when it is placed against the antenna, the built-in motor extends the nail one millimetre per day. When the leg has grown to the desired length, lengthening stops, and the bone is allowed to solidify.
• The device can be removed about two years after the initial surgery.

This procedure, however, comes at a price. While the Ilizarov external fixator costs approximately US$4,000, and the ISKD implant about US$8,000, the Fitbone device carries a price tag of roughly US$15,000 (all prices exclusive of surgery costs).

The Bliskunov device is currently not available.

Future technology

Due to shortcomings of current external and internal devices and the evident market potential of cosmetic limb elongation, a growing number of companies are researching potential intramedullary technologies. These include:

• Concepts based on electromagnetic actuation
• Concepts based on smart material integration
• Concepts based on manual actuation
• Concepts based on electronic actuation

Biotechnological advances, such as in stem cell research, may become the next generation standard of care for limb elongation once it matures, possibly within a decade or two.

General solid bone regeneration

Distraction rate

The most important aspects for the success of bone distraction are an intact medullary blood supply, preservation of soft-tissue envelope, primarily the periosteum (which helps preserve the blood supply) and secondarly bone marrow and the stability of the fixator.

The distraction rate must be gradual, as a rapid rate of distraction will result in a fibrous union in which the bone pieces are joined by fibrous, rather than osseous tissue.

Too slow of a distraction rate would result in early bone consolidation. A common distraction rate for lower limbs is 1 millimeter per day.

Cosmetic lengthening of limbs

Generally, doctors tend to discourage cosmetic lengthening for people who want to add a couple of inches to their frames

People insistent on doing the procedure, however, are required by some doctors to undergo a thorough body image assessment by a psychologist to help determine how far the person’s quality of life has been affected by his perceived lack of height, and if doing the surgery will make a marked difference.

Me: This will be only the first of many posts I will write that looks at the different types of surgeries and methods available that can lengthen one’s legs and limbs. In my personal opinion, there is still a lot of science and innovation that can go into this type of surgery. It may be possible within 20 years that people can choose to go in to a clinic and get their limbs lengthened and height increase as easily as going to get a breast implant or laser eye surgery. Of all the methods reviewed so far, distraction osteogenesis is still the most common way to gain height with clear results. It was reported in popular fiction that in the movie Gattaca (starring Ethan Hawke and Uma Thurman) the main character and the original James Bond villain Dr. No that they both had limb lengthening surgery done to either look more intimidating or hide their identities.