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Sunday, April 10, 2016

Indian man undergoes surgery to lengthen his legs

He slipped out of his home with 200,000 rupees in cash and some jewellery and underwent the limb-lengthening Ilizarov procedure.

When a 23-year-old-software engineer Nikhil Reddy got himself admitted to a corporate hospital in Hyderabad last week for what he thought was a cosmetic surgical procedure, little did he realize that his adventure would create a storm in medical circles.

The techie is 5.7 feet tall and desperately wanted to increase his height by about three inches. After consulting orthopedic surgeons at Global Hospitals, a high-profile private hospital, he opted for limb-lengthening operation that would cost Rs 700,000.

Without informing his parents, Nikhil, a resident of Petbasheerabad area in the city, simply slipped out of his home one fine day with Rs 200,000 in cash and some jewellery and underwent the procedure. The troubles started soon after.

The worried parents filed a missing report with the police, only to discover later that Nikhil was actually admitted in the hospital for a surgery that not many people have even heard of.

After finding their son at the post-operative ward, with surgical clippers fixed to both his legs, the parents raised a hue and cry and complained against the hospital authorities for conducting a major surgery on their son without even informing them.

Nikhil will require at least six months of treatment to start walking again.

Limb-lengthening by Ilizarov method, also called 'deformity-correction' surgery, is used to lengthen the deformed or missing bones. The surgery is mostly conducted on people who have unequal limbs, for correcting dwarfism, or in accident cases when the limbs are damaged. It is a painful surgical procedure that requires intense post-operative care for several months.

The case raised ethical questions over the conduct of the hospital authorities and whether the surgery was really needed in the case of Nikhil who, at 5 ft 7 inches, is reasonably tall by Indian standards. The parents are now demanding action against the hospital.

However, the hospital authorities said that since Nikhil is a major, there was no need to take consent from his parents. The hospital also clarified that the surgery does not fall under the clinical guidelines of medico-legal cases and hence the police was not informed of the same.

"The patient has been fully explained about the risk, cost of treatment and due consent was taken from the patient and treatment given. As per the declaration the patient has given the date of birth as January 23rd, 1994 and the hospital in no way is legally bound to check the credentials and background of the patient unless anything suspicious is noted," a statement from the hospital said.

Meanwhile, the city police has registered a case against Global Hospital under section 336 of IPC that deals with endangering the life or personal safety of a person.

Taking suo motu cognizance of the controversy, the Telangana State Medical Council (TSMC) has summoned the doctors, involved in the surgery, to appear before its ethics committee on April 20 to explain their stand on what they called an "unusual experimental surgery on a young person".

The TSMC has taken up the case after several members of the medical fraternity raised ethical issues as to why the team led by Dr G Chandra Bhushan, the chief orthopaedic surgeon, agreed to perform the operation. "We want to know why Nikhil was selected for the limb-lengthening technique in the first place as there seems to be no such emergency in the case," said Dr E Ravindra Reddy, chairman, TSMC.

He said that the ethics committee of TSMC would take a final call based on the surgeons' response.

The Orthopedic Association of South Indian States (OASIS) has also taken cognizance of the case and constituted a technical committee for an internal probe into the case to ascertain whether the patient actually needed to undergo the surgery using Ilizarov technique for cosmetic reasons and whether the surgery was done as per the rule book.

"Though Ilizarov technique is a medically proven limb-lengthening technique, it is mostly performed in cases where pathological reasons are found such as when one leg being shorter than other or on a polio-afflicted patient facing mobility issues or someone who has met with an accident with multiple fractures," said Dr P Vijayachandra Reddy, secretary general, OASIS.

However, the Telangana Orthopedic Surgeons Association (TOSA) has come out strongly in support of Global Hospitals, saying the limb lengthening and reconstruction surgery is legal and the image of the doctor should not be tarnished.

Dr Gopal Reddy, president of the association said, "Hyderabad is a medical hub and cosmetic surgeries can be perwformed here. If parents are emotionally upset, the doctor's 30 years' experience cannot be tarnished."

What is Ilizarov Technique?

The technique involves cutting the tibia (long bone between knee and ankle) into two, leaving small gaps for bones to grow gradually. It is attached with an Ilizarov fixator that has steel rods, rings and wires supporting the structure and wait for months before the bone starts growing, filling the gap with fresh muscles, nerves and skin.

For the bone to grow a length of 3 inches, it takes about 6 to 10 months.

The procedure was first performed by Prof. G A Ilizarov, a Russian orthopedic, in 1972. The limb lengthening is one of the applications of his extensive work on distraction ontogenesis.

In most developing countries, it is a highly specialized technique used mainly for deformity correction by experienced surgeons due to its complexity. After the surgical operation and stretching period, the external devise is removed from patient's leg and internal device is locked at lower end.

The procedure is usually performed for both legs at the same time. The maximum possible leg lengthening is 7-10 cm in leg bones. The whole process of leg-lengthening procedure can take 6 to 9 months. Once healing is complete, a second surgery is necessary to remove the ring apparatus. The result is a limb that is significantly longer.

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