The periosteum appears just below the skin.
Distraction osteogenesis, also called callus distraction, callotasis, and osteodistraction, is a surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body. A corticotomy is used to fracture the bone into two segments, and the two bone ends of the bone are gradually moved apart during the distraction phase, allowing new bone to form in the gap. When the desired or possible length is reached, a consolidation phase follows in which the bone is allowed to keep healing. Distraction osteogenesis has the benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.[medical citation needed]
Although distraction technology has been used mainly in the field of orthopedics, early results in rats and humans indicated that the process can be applied to correct deformities of the jaw. These techniques are now extensively used by maxillofacial surgeons for the correction of micrognathia, midface, and fronto-orbital hypoplasia in patients with craniofacial deformities.[medical citation needed]
The most important aspects for the success of bone distraction are an intact medullary blood supply, preservation of soft-tissue envelope, primarily the periosteum (which helps preserve the blood supply) and secondarly bone marrow and the stability of the fixator.
The distraction rate must be gradual, as a rapid rate of distraction will result in a fibrous union in which the bone pieces are joined by fibrous, rather than osseous tissue. Too slow of a distraction rate would result in early bone consolidation. A common distraction rate for lower limbs is 1 millimeter per day.
In 1905, Alessandro Codivilla introduced surgical practices for lengthening of the lower limbs. Early techniques had a high number of complications, particularly during healing, and often resulted in a failure to achieve the goal of the surgery.
In 1934, the New York Hospital For Joint Disease worked on an early method developed by Ilizarov. The major item that the US team of surgeons developed was the metal frame the leg was placed in to hold it perfectly in place until the cut made in the bone was healed over.
The breakthrough came with a technique introduced by Russian orthopedic surgeon Gavriil Ilizarov. Ilizarov developed a procedure based on the biology of the bone and on the ability of the surrounding soft-tissues to regenerate under tension; the technique involved an external fixator, the Ilizarov apparatus, structured as a modular ring. Although the types of complications remained the same (infection, the most common complication occurring particularly along the pin tracks, pain, nerve and soft tissue irritation) the Ilizarov technique reduced the frequency and severity of the complications. The Ilizarov technique made the surgery safer, and allowed the goal of lengthening the limb to be achieved.
- Distraction Osteogenesis at eMedicine
- De Bastiani 1987
- Tavakoli 1998
- Paley 1997
- Aquerreta 1994
- Mehrara 1999
- Chin, M.; Toth, B.A. (1996). "Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases.". J Oral Maxillofac Surg. 54 (1): 45–53. doi:10.1016/S0278-2391(96)90303-1. PMID 8530999.
- Guichet, Jean-Marc; Barbara Deromedis; Leo T. Donnan; Giovanni Peretti; Pierre Lascombes; Flavio Bado (1 May 2003). "Gradual Femoral Lengthening with the Albizzia Intramedullary Nail" (abstract). The Journal of Bone and Joint Surgery (American). 85–A (5): 838–848. PMID 12728034.
- Delloye, C; Delefortrie G; Coutelier L; Vincent A. (January 1990). "Bone regenerate formation in cortical bone during distraction lengthening. An experimental study" (abstract). Clinical Orthopaedics & Related Research. 250: 34–42. doi:10.1097/00003086-199001000-00005.
- Aldegheri, R (1993). "Callotasis". Journal of Pediatric Orthopaedics.
- Guichet, Jean-Marc (September 1999). Bone formation during limb lengthening. Animal experimentation with and without preservation of the bone marrow and/or periosteum. New York: New York University.[page needed]
- Warren SM, Mehrara BJ, Steinbrech DS, et al. (February 2001). "Rat mandibular distraction osteogenesis: part III. Gradual distraction versus acute lengthening". Plast. Reconstr. Surg. 107 (2): 441–53. doi:10.1097/00006534-200102000-00021. PMID 11214060.
- fibrous union on biologyonline
- ALDEGHERI, R. (May 1999). "Distraction Osteogenesis for Lengthening of the Tibia in Patients Who Have Limb-Length Discrepancy or Short Stature". The Journal of Bone and Joint Surgery. 81 (5): 624–634. PMID 10360691.
- Codivilla, Alessandro (1905). "On the means of lengthening in the lower limbs, the muscles, and tissues which are shortened through deformity". American Journal of Orthopedics Surgery. 2: 353–69.
- Mosca, V; Moseley, CF (1986). "Complications of Wagner leg lengthening and their avoidance". Orthop. Trans. 10: 462.
- Baumgart, Rainer; Betz, Augustin; Schweiberer, Leonhard (1997). "A Fully Implantable Motorized Intramedullary Nail for Limb Lengthening and Bone Transport". Clinical Orthopaedics and Related Research (343): 135–43. PMID 9345218.
- "Surgeon stretches crippled legs". Popular Science. September 1934.
- Paley, Dror (1990). "Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique". Clinical Orthopaedics and Related Research (250): 81–104. doi:10.1097/00003086-199001000-00011. PMID 2403498.
- Paley, Dror (1988). "Current techniques of limb lengthening". Journal of Pediatric Orthopaedics. 8 (1): 73–92. doi:10.1097/01241398-198801000-00018. PMID 3275690.
- Aquerreta, J.D.; Forriol, F.; Cañadell, J. (1994). "Complications of bone lengthening". International Orthopaedics. 18 (5): 299–303. doi:10.1007/BF00180230. PMID 7852010.
- Chin, Martin; Toth, Bryant A (1996). "Distraction osteogenesis in maxillofacial surgery using internal devices: Review of five cases". Journal of Oral and Maxillofacial Surgery. 54 (1): 45–53; discussion 54. doi:10.1016/S0278-2391(96)90303-1. PMID 8530999.
- De Bastiani, Giovanni; Aldegheri, Roberto; Renzi-Brivio, Lodovico; Trivella, Giampaolo (1987). "Limb Lengthening by Callus Distraction (Callotasis)". Journal of Pediatric Orthopedics. 7 (2): 129–34. doi:10.1097/01241398-198703000-00002. PMID 3558791.
- Mehrara, Babak J.; Rowe, Norman M.; Steinbrech, Douglas S.; Dudziak, Matthew E.; Saadeh, Pierre B.; McCarthy, Joseph G.; Gittes, George K.; Longaker, Michael T. (1999). "Rat Mandibular Distraction Osteogenesis: II. Molecular Analysis of Transforming Growth Factor Beta-1 and Osteocalcin Gene Expression". Plastic and Reconstructive Surgery. 103 (2): 536–47. doi:10.1097/00006534-199902000-00026. PMID 9950542.
- Paley, Dror; Herzenberg, John E.; Paremain, Guy; Bhave, Anil (1997). "Femoral Lengthening over an Intramedullary Nail. A Matched-Case Comparison with Ilizarov Femoral Lengthening". The Journal of Bone and Joint Surgery. 79 (10): 1464–80. PMID 9378732.
- Tavakoli, Kourosh; Walsh, W.R.; Bonar, Fiona; Smart, Richard; Wulf, Sue; Poole, Michael D. (1998). "The role of latency in mandibular osteodistraction". Journal of Cranio-Maxillofacial Surgery. 26 (4): 209–19. doi:10.1016/S1010-5182(98)80016-4. PMID 9777499.
- Simpson AH, Cole AS, Kenwright J (1999). "Leg lengthening over an intramedullary nail" (pdf). J Bone Joint Surg Br. 81 (6): 1041–5. doi:10.1302/0301-620X.81B6.9359. PMID 10615983.
- Distraction Osteogenesis information from Seattle Children's Hospital Craniofacial Center