The Ilizarov Method
Ilizarov method is a system in which bone is fixed with thin wires and rings.
EXTREMITY LENGTHENING AND RECONSTRUCTION CONCEPT
Extremity lengthening and reconstruction techniques are used for filling bone defects and correcting and lengthening bones with deformity.
These procedures can be applied to pediatric or adult patients (3-70 years) with congenital disease, bone loss or traumatic limb length inequality. The procedure for extremity lengthening and deformity correction is carried out according to the principles of distraction osteogenesis. This concept was a revolution which destroyed the historical view that bone can not be lengthened. In this technique, bone is cut with surgery and lengthened gradually; new bone formation (osteogenesis) is observed in lengthening site. Bone can be lengthened up to 15%-100% of its original length with this method. At Istanbul University Istanbul Faculty of Medicine, Department of Orthopedics and Traumatologyangular deformities are corrected together with extremity lengthening using monolateral and circular external fixators. In this way, patients who had no treatment options previously gain an oppotunity for treatment in our clinic.
The clinical team of the departmant consists of orthopedic surgeons, residents, physiotherapists, nurses and supporting personnel who are experienced educated in all fields of reconstructive surgery. Besides, experimental and clinical studies are carried out in our clinic in order to develop biological principles and surgical techniques of extremity lengthening.
THE METHOD FOR EXTREMITY LENGTHENING AND RECONSTRUCTION
Step 1. Consultation and First Evaluation
The patient who applied to the outpatient clinic for treatment is examined. Appropriate X-rays and tests are ordered. If surgical treatment is indicated, the team and the patient discuss all appropriate treatment alternatives and the optimal surgical technique is selected.
Step 2. Surgery
Before the operation, the suitable device is prepared and tried on the patient. This device is fixed to patients’s bone with wires and screws. The operation is done through one or two incisions of a few centimeters. Maximum care is provided during bone cutting in order to inflict minimum damage to bone and surrounding soft tissues.
Step 3. Treatment and Rehabilitation Following Surgery
Lengthening is usually commenced at 1. week after the operation. The two ends of cut bone are separated by 1 mm daily. The patients are usually hospitalized for 3-7 days in our clinic. They may have to stay longer in complicated cases. Rehabilitation is started at 1. or 2. day after the operation.
The purpose of rehabilitation is to maintain the tightness of muscles in order to preserve the range of motion. Standing, weight bearing over the operated leg and walking is permitted a few days after the operation.
After discharge from the hospital, physical therapy is the most importatant step of treatment. In complicated cases, physical therapy may be applied after hospital admission if required. All patients are encouraged to continue daily activities such as going to the school and work. Walking with the device and taking a shower with disinfectant materials are also permitted.
Step 4. Consolidation
No adjustment is performed after the extremity reaches the required length and alignment. When it is decided that new bone has acquired enough strength, the device is taken out with local or general anesthesia. Prophylactic casting or bracing (with plastic orthesis) is applied for 1-2 months.
Follow-up period differs for individual patients. Usually patients are controlled every 2-3 weeks in our clinic.