Transverse distraction osteogenesis : New chances for limb salvage?

Abstract

Distraction osteogenesis (DO) is atechnique that can be successfully used to treat leg length discrepancies and to reconstruct long defects of bone. By gradual distraction of the bone fragments by approximately 1 mm per day, hypervascularization and an increased bone healing potential (growth stimulus) occur. So far, DO has almost exclusively been used longitudinally to generate new biologically active bone. Chronic wounds, ulcers and osteitis, especially in the region of the foot, are always achallenge for the treating surgeon, since treatment is tedious, the outcome uncertain and associated with possible loss of the extremity. Transverse distraction osteogenesis (tDO) now uses the growth stimulus of the DO translationally to treat distally located, chronic wounds and thus leads to accelerated wound healing. At the end of the 5‑week treatment, the transversely distracted fragment, located far proximal to the chronic wound, is back in its original location. The biological stimulus has along-lasting effect, longer than the tDO itself. Further investigations into the mechanisms of action and treatment outcomes of tDO are required. If the previous results are confirmed, tDO may become agame changer and enable the limb salvage for alarge proportion of findings that previously required amputation.