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Limb Lengthening & Reconstruction Center

The UCSF Limb Lengthening and Complex Reconstruction Center is a specialized center dedicated to providing comprehensive care for children with limb length discrepancies or deformities and associated conditions of the upper and lower extremities. Regardless of underlying complexity, these conditions require care from many specialists, and our multidisciplinary team has the training and experience to use advanced therapeutic and surgical techniques that ultimately enable children to reach their highest levels of function, mobility and comfort.

Our goal is to help your child be as active and functional as possible. We offer a full range of treatment options, both with and without surgery.

Advanced reconstruction techniques and multidisciplinary collaboration

Our team includes pediatric orthopedic surgeons with advanced skills in limb lengthening, deformity correction and complex limb reconstruction. Special expertise includes:

  • Orthopedic oncology
  • Orthopedic trauma
  • Rehabilitation medicine

Because we can offer the resources of a large pediatric research hospital, our patients have access to experts in numerous subspecialties. These include:

  • Hand surgery and microsurgery
  • Occupational therapy
  • Physical therapy
  • Plastic surgery
  • Prosthetics and orthotics
  • Sports medicine

Rehabilitation therapy is key to recovery. We provide comprehensive rehab services for children, with amenities including:

  • A dedicated inpatient rehabilitation unit
  • A 17,000-square-foot rehabilitation center, with a spacious physical therapy gym and an outdoor terrain park
  • Outpatient therapy access at all locations

Limb lengthening

Surgical techniques for limb lengthening harness the body's own healing ability through the regeneration of bone and soft tissues (such as skin, muscle, nerves and blood vessels). The medical method called distraction osteogenesis involves the gradual pulling apart (distraction) of a surgically cut bone, allowing for new bone growth (osteogenesis) in the created gap. That new bone hardens and becomes as strong as any other bone in the body.

Complex reconstructive surgery

Several methods may be helpful, depending on the specifics of your child's condition. These include changing the limb's shape and alignment using a variety of techniques and implants. Additionally, defects and deficiencies in soft tissues can be addressed through advanced procedures, such as soft tissue flaps, microvascular surgery and tendon transfers.

We offer expertise in the following techniques and services:

  • Advanced physical therapy
  • Amputation reconstruction
  • Bio-integrated and expandable prosthesis
  • Computerized hexapod external fixators
  • Customized orthotics and prosthetics
  • Electromyography
  • Guided growth
  • Hinged distraction across joints
  • Masquelet technique
  • Medical Botox therapy
  • Microvascular surgery and tissue transfer
  • Percutaneous osteotomy
  • Prenatal consultation
  • Remote-controlled magnetic lengthening nails

Conditions we treat

Our team is experienced in diagnosis and care for a range of pediatric disorders of the extremities, including:

  • Limb length discrepancy (upper or lower limb)
  • Upper and lower limb deficiencies
  • Congenital leg length conditions:
    • Congenital femoral deficiency (proximal femoral focal deformity)
    • Fibular deficiency/fibular hemimelia
    • Tibia deficiency/tibial hemimelia
  • Developmental limb deformities:
    • Blount's disease
    • Congenital pseudoarthrosis of the tibia
  • Acquired deformities:
    • Deformities caused by noncancerous or cancerous tumors
    • Infection in a bone (osteomyelitis) or joint (septic arthritis)
    • Soft tissue scarring, such as may occur after burns or multiple surgeries for clubfoot correction
    • Traumatic injuries, including growth plate fractures, malunion (poor alignment in a healed fracture), nonunion (an incompletely healed fracture), shortening and deformity due to bone loss
  • Short stature:
    • Achondroplasia and other bone growth disorders
    • Limb length and angular deformities linked to dwarfism
  • Pediatric hip disorders, such as:
    • Developmental coxa vara
    • Legg-Calve-Perthes disease
    • Slipped capital femoral epiphysis
  • Limb differences linked to complex syndromes, such as:
    • Amniotic band syndrome
    • Apert syndrome
    • Arthrogryposis
    • Osteogenesis imperfecta
  • Bone loss as a result of an injury, tumor or infection
  • Early stages of arthritis

Leadership

The Limb Lengthening and Complex Reconstruction Center at UCSF Benioff Children's Hospital Oakland is directed by Sanjeev Sabharwal, MD.

With more than two decades of experience, Sabharwal has distinguished himself as a leader in the treatment of limb deformities in children. He is a frequent speaker at national and international orthopedic medicine symposiums and has served as president of the Limb Lengthening and Reconstruction Society. He is editor of a comprehensive clinical textbook titled Pediatric Lower Limb Deformities: Principles and Techniques of Management. He serves as deputy editor for two eminent orthopedic journals, Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research.

Sabharwal's research focuses on advancing the science of limb lengthening and limb deformity correction, including the technique of distraction osteogenesis. He examines patient-centered innovation, works to develop patient-reported outcome measures for limb deformities, and studies the motivations and impact of global orthopedic volunteerism.

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    Awards & recognition

    • One of the nation's best in orthopedics

    • Ranked among the nation's best in 10 specialties

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    What to Bring

    • Photo I.D.
    • Health insurance card
    • Insurance authorization, if required
    • Doctor's referral, if required
    • Recent test results related to your child's condition
    • List of medications, including dosages, plus any your child is allergic to
    • List of questions you may have
    • Device or paper for taking notes

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    Your Stay

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    Your Child's Care Team

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    Interpreter Services & Communication Assistance

    Interpreter services in many languages and TDDs are available for families that need help communicating with care teams. Here's how to access them.

    Family Resource Center

    We help families cope with the challenges of childhood illness and hospitalization in a relaxing environment where parents can get a much-needed break.

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    Parent Support Program

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    Spiritual Care

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    International Services

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