Page 13 - The Outcome Question Continued

At present one can find many stature lengthening centers advertised on the internet. How should the consumer decide among these? This is an unregulated business. The methods vary tremendously, as do the results. The cost of treatment in some foreign countries is an eighth to a 10th of the cost in the United States.

It is not our intention to condemn or advocate for any particular surgeon or center. However, we do feel that the results of the PRECICE method are ideal and better suited for this type of surgery than previous methods. For years the external fixator was the gold standard of limb lengthening. It offered the advantage of a minimally invasive surgery, with stable fixation, controlled rate and rhythm of distraction and even the ability to go reverse. It had the disadvantages of being in place for lengthy periods of time, painful tethering of muscles and skin, long, unaesthetic scars at the pin tracks, infections of the pin sites and no support for the bone after removal of the apparatus, putting the bone at risk for bending or breaking. The PRECICE ILN offers all of the advantages of the external fixator without the disadvantages. By not tethering the muscles or skin, it is less painful and motion limiting. There are fewer, smaller, and more aesthetic scars and no infections. For the first time we have a device and a method that are ideal for SSL.

Some surgeons believe the indications for stature lengthening are frivolous and unfounded. We hope to have dispelled this argument, as well as the negative association with “cosmetic surgery.” Unlike other cosmetic procedures, SSL places significant psychological and physical demands on patients and their families. The recovery is significantly more protracted and puts patients in wheelchairs, walker, or crutches for several months and requires months of rehabilitation. Patients frequently do not return to walking normally for 6 or more months. Such intensive rehabilitation is not required for other cosmetic procedures. This procedure is a significant disruption to patients’ lives (eg, personal, school, work, family, financial stress). Finally, most cosmetic procedures are less labor intensive to both the clinical team and the patient, do not require an inpatient surgery setting, frequent follow-up with x-rays, technical and clinical support for the hardware, and a constant vigilance for potential complications. As such we do not look at this as cosmetic surgery for purely aesthetic reasons. In the majority of patients it is being done because of a body image disorder that is beyond the patient’s control. Although at present “stature dysphoria” is not recognized as psychological disorder that is best treated by surgical reconstruction, the new evidence reported here supports this conclusion.

Orthopedic surgeons are not used to performing surgery for cosmetic reasons. On the basis of the senior author’s 28-year history of carrying out SSL, we would like to propose the following “ethical guidelines for SSL”: (1) the surgeon should consider patient safety and welfare first at all times—first do no harm (primum non nocere; Hippocratic oath in Latin); (2) the surgeon should make sure that patients are knowledgeable and really understand what they are undertaking including the nature of their condition, the way it is to be treated including the timelines for temporary disability, the risks of the procedure, and the prognosis; (3) the surgeon should not undertake this procedure unless he/she not only knows how to do the procedure but also how to prevent and treat complications in order to increase the likelihood of a successful outcome;41–49,56 and (4) provide the necessary infrastructure to support this treatment (eg, physical therapy, frequent follow-up, technical support).

References to follow on next page.