Limb Lengthening & Complex Reconstruction Center

The Pediatric Limb Lengthening and Complex Reconstruction Center is dedicated to providing comprehensive care for children and young adults with limb length differences or deformities of the upper or lower extremities. These conditions require care from many types of specialists, and our team has the training and experience to use advanced techniques that can enable all individuals to reach their highest levels of function, mobility and comfort.

Our goal is to help our patients maximize their physical activity and functional ability using the least invasive approaches possible. We offer a full range of surgical and nonsurgical treatment options.

We welcome international patients seeking access to our innovative care models. If you live outside the United States, UCSF International Services can help with coordinating care.

Advanced reconstruction techniques and collaboration among experts

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

Because we are a large pediatric institution that serves the entire Bay Area and beyond, our patients have access to experts in numerous subspecialties. These include:

• Pediatric orthopedics
• Orthopedic trauma
• Orthopedic oncology
• Sports medicine
• Hand surgery and microsurgery
• Rehabilitation medicine
• Physical therapy
• Occupational therapy
• Prosthetics and orthotics
• Plastic surgery
• Prenatal consultation

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 ability to heal and regenerate 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 ultimately becomes at least as strong as any other bone in the body.

Complex reconstructive surgery

We use several approaches – both traditional and cutting-edge – to restore the anatomy and function of short and deformed limbs. We can change a limb's shape and alignment with a variety of techniques and implants. Additionally, we can address defects and deficiencies in soft tissues through advanced procedures, such as soft tissue flaps, microvascular surgery and tendon transfers.

We offer in-house expertise in the following techniques and services:

• Computerized hexapod external fixators (orthopedic system that corrects deformities on multiple planes)
• Remote-controlled magnetic lengthening nails
• Joint preservation surgery
• Guided growth surgery
• Amputation reconstruction
• Osteointegration
• Advanced inpatient and outpatient physical therapy
• Customized orthotics and prosthetics
• Electromyography
• Masquelet technique (a combination of a temporary spacer and bone grafting)
• Microvascular surgery and tissue transfer
• Minimally invasive surgery, including osteotomies

Conditions we treat

Our team is experienced in diagnosing and caring for pediatric patients with all types of extremity disorders, including:

• Limb length discrepancies (upper and lower limbs)
• Limb deficiencies and differences
• Congenital leg length conditions, including:
  • Congenital femoral deficiency (proximal femoral focal deformity)
  • Fibular deficiency or hemimelia
  • Tibial deficiency or hemimelia
• Developmental limb conditions, including:
  • Blount's disease
  • Congenital pseudoarthrosis of the tibia
• Acquired deformities:
  • Shortening or deformities caused by tumors
  • Infection in a bone (osteomyelitis) or joint (septic arthritis)
  • Soft tissue scarring, such as may occur after burns or multiple surgeries to correct clubfoot
  • 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 hip, knee and ankle arthritis

Leadership

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

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

Sabharwal's research focuses on advancing the science of limb lengthening and limb deformity correction, including the technique of distraction osteogenesis. His research interests include examining patient-centered innovations related to limb lengthening, developing patient-reported outcome measures for limb deformities, and global orthopedics.