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
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- Tavakoli 1998
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- fibrous union on biologyonline
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- 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. 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.
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- Distraction Osteogenesis information from Seattle Children's Hospital Craniofacial Center