Dr Franz Birkholtz - CLL in Stellenbosch, South Africa

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hello Dr B, it might be a stupid question, but i wanted to ask u if theres any differences in therms of risks between people who smoke or use nicotine pouches before the surgery, how for example using nicotine pouches before the surgery would affect my healing etc etc... and in case how much earlier before undergoing the surgery a person should stop using them, thank u Dr

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Quote from: dylan_stt on July 31, 2024, 12:39:12 PMhello Dr B, it might be a stupid question, but i wanted to ask u if theres any differences in therms of risks between people who smoke or use nicotine pouches before the surgery, how for example using nicotine pouches before the surgery would affect my healing etc etc... and in case how much earlier before undergoing the surgery a person should stop using them, thank u Dr

Data suggests that nicotine patches slow down bone healing significantly. I would use the same rule as for smokers and say three months clean at least.

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Quote from: Franz on July 31, 2024, 06:31:37 PMData suggests that nicotine patches slow down bone healing significantly. I would use the same rule as for smokers and say three months clean at least.

got it, thank u dr

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Hello Doctor,

I see that you recommend 6.5 cm max for femurs. What is your current recommendation for maximum safe lengthening of tibias with LON method? And do you still accept patients of <165cm or any height is fine (I'm 173cm)?

I wonder about tibias because I really worry that change in mechanical axis due to lengthening over anatomical axis may make knees closer and affect knees or femoral head "resource" in the long run. While tibias since they are just straight bones sound safer in terms of keeping native biomechanics.

Thanks!

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Dear Dr Birkholtz

I am enquiring as to how many limb lengthening procedures (cosmetic) you have conducted throughout your career, and were there any cases of fat embolisms? If there were, were you able to rectify them?

Thank you for your time.

Kind regards
The Struggler

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Hi

I accept patients on an individual basis, regardless of their starting height within reason. I am more likely to offer stature lengthening to a patient with a starting height of 165 cm than one of 185cm.

Femoral general guideline with nail is 6.5 for optimal safety, but can usually extend to 8cm in most cases.

Tibial nail limit around 4.5-5cm.
LON limit 6cm.

F

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I do not count my cases specifically and the percentage fat embolism as a percentage is not a guarantee of safety or risk. It is mainly dependent on genetics.

I did recently have a significant fat embolism syndrome which we picked up within hours, responded to timeously and turned around.

I am comfortable that the protocols we have in place make it as safe as possible.

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Thank you Dr Birkholtz for your timely response.

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Quote from: Franz on September 03, 2024, 12:57:52 PMHi

I accept patients on an individual basis, regardless of their starting height within reason. I am more likely to offer stature lengthening to a patient with a starting height of 165 cm than one of 185cm.

Femoral general guideline with nail is 6.5 for optimal safety, but can usually extend to 8cm in most cases.

Tibial nail limit around 4.5-5cm.
LON limit 6cm.

F
Thank you for the reply, Doctor.

Could you please also tell if using LON for Tibia assumes pins passing through muscles or they are placed closer to frontal part of leg and do not pass muscles and other soft tissues?

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We use the well described 'safe zones' based on cross sectional anatomy. To have the greatest biomechanical benefits from circular fixation, the fixation elements need to cross at certain angles. This means that there will be some transfixing of muscle. But we attempt to minimise this as much as possible.