Comment to:
“Height enhancement using hyaluronic acid and minimally invasive technique”
Martusciello pouch
There is no reason to doubt this space exists, as described by Dr. Martusciello, but beyond the ultrasound findings, in truth far from conclusive, it would be very useful to have anatomical validation at the dissection table. To date, this space has not been described in the main anatomy books, not even under a different name.
Photographic depictions
The photos shown do not clearly indicate the height increase described in the text: it would be very useful, not with standing the incorrect caption of photo 7, to take photographs with centimetre grid paper in the background in order to appreciate the actual result.
Pain
The Author does not dwell on the painfulness of the implant, which according to us must be far from negligible. On the other hand, despite not disclosing the therapy cycle, the Author reports they have prescribed opioids and sometimes NSAIDs to control it. By inference it seems therefore clear that the manoeuvre must be significantly painful and, it should be noted, opioids often have severe side effects that may even prevent social activities. Finally, one could at least have used one of the multidimensional scales (Mc. Gill Pain Questionnaire, Wisconsin-Madison, Brief Pain Inventory etc.) or uni-dimensional scales (VAS, NRS, VRS) or VAS, Visual Analogue Scale, to provide more correct information on the pain.
Ilizarov
The Author seems to have drawn inspiration from the Ilizarov technique to justify their work. However, Ilizarov, as well as the most recent work reported, designed his technique for certain types of fractures, as well as for lengthening dwarfs with severe achondroplasia, nothing to do with lengthening of few centimetres for aesthetic purposes. Therefore the comparison with the Ilizarov technique does not appear to be justifiable.
REFERENCES
1. Goldstein RY, Jordan CJ, McLaurin TM, Grant A. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis (2013). 2013; 71(1):96-103.
2. Jordan CJ, Goldstein RY, McLaurin TM, Grant A. The evolution of the Ilizarov technique: part 1: the history of limb lengthening. Bull Hosp Jt Dis (2013). 2013; 71(1):89-95.
3. Khanfour AA. Versatility of Ilizarov technique in difficult cases of ankle arthrodesis and review of literature. Foot Ankle Surg. 2013; 19(1):42-7.