Distraction Osteogenesis For Reconstruction Research Articles

Distraction Osteogenesis Reconstruction Following Resection of Bone Sarcomas: Surgical, Functional, and Oncological Outcomes from a Prospective Trial Analysis.

While sustainable long-term function has been established for biological reconstruction with distraction osteogenesis (DO) following osseous resections, there is a paucity of published data informing surgeons and patients on important milestones in the reconstructive process. The objectives of this study were to determine when to expect complete bone healing and full weight-bearing as well as to quantify the influence of chemotherapy on the osseous regeneration process. Prospectively, pathological and clinical data were collected for 30 consecutive patients who underwent primary or secondary DO-based reconstruction following osseous resection from 2018 to 2021. Serial radiographs indicated the times to cortex formation and full union. An unpaired t test was used to compare the time required for full bone remodeling of segments transported with and without concurrent chemotherapy. The average resection length was 13.6 cm (range, 4 to 22 cm). Patients underwent an average of 6.1 procedures (range, 1 to 14 procedures). Half (50%) of all procedures were planned, while half were unplanned procedures. All patients achieved full, independent weight-bearing at a median of 12 months (interquartile range [IQR], 9 to 16 months). For the 34 segments transported concurrently with chemotherapy, the mean bone healing index (BHI) was 2.3 ± 0.7, and the mean BHI was 1.2 ± 0.4 for the 25 segments without chemotherapy at any point during their transport (p < 0.0001). All 30 patients achieved full bone healing and independent weight-bearing at a median of 1 year postoperatively and continued to show functional improvement afterward. Surgeons and patients can expect bone healing to be nearly twice as fast for segments transported after completion of systemic chemotherapy compared with segments transported concurrently with adjuvant chemotherapy. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Reconstruction of massive tibial defects after resection of adamantinoma with double-level distraction osteogenesis

Adamantinoma is an extremely rare disease that typically involves large portions of the tibial cortex requiring extensive resections, for which a myriad of complex reconstructions have been performed with varying success. Techniques of bone regeneration utilizing internal or external methods are used to manage bone defects in trauma, infection and congenital deformities, but less commonly used for oncological osseous defects. We present four cases of patients diagnosed between 2015 – 2018 with tibial adamantinoma in a background of osteofibrous dysplasia who underwent distraction osteogenesis reconstruction via a double level cable bone transport. In all cases wide resection of the adamantinoma was performed to achieve negative surgical margins and the defect reconstructed by double level bone transport using Ilizarov cables guiding distraction osteogenesis. Bone transport occurred at a combined mean rate of 2 mm per day: 1mm proximally and 1mm distally. Full weight-bearing and ambulation were encouraged immediately. The mean age at time of surgery was 18 years (14 – 25) and the mean size of tibial defect was 23 cm (17.5 – 26). The mean time in external fixation was 8.5 months (6 – 12 months), yielding a mean External-Fixation Index (EFI) of 0.44 month/cm (0.3 – 0.69). The average MSTS score at mean follow time of 20 months (13-27 months) is 28 (26 – 30). At last follow up all patients are infection free and without evidence of disease. Despite typical complications of prolonged external fixation, all four patients have excellent results with an average MSTS score of 28. The mean EFI of 0.44 month/cm is well below the standard EFI of 1 month/cm, suggesting this subset of patients may require less external fixation time than previously considered. The case series supports the hypothesis that double level D.

Transport Distraction Osteogenesis in Reconstruction of Condyle: Use of a 3D Model for Vector Planning.

The temporomandibular joint (TMJ) is a complex joint, and it allows bilateral synchronous rotatory and translatory movements. TMJ reconstruction has evolved as an important step in the management of conditions affecting the TMJ like ankylosis, traumatic injuries and congenital deformities. Distraction osteogenesis (DO) is a biological process of forming new bone and adjacent soft tissues by gradual and controlled traction applied on osteotomized bone segments. Here is a case report of bilateral TMJ ankylosis which was managed effectively by resection of ankylotic mass and reconstruction of TMJ by transport distraction osteogenesis with preoperative vector planning using a 3D printed model. Distraction osteogenesis can be considered as an effective means of condylar reconstruction for an anatomical and functional TMJ with minimal complications. Use of 3D models can help making such complex TMJ reconstruction procedures simpler.

Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits.

Successful cure is achieved in almost 70% of patients with primary bone sarcomas with currently available therapies. Some soft tissue sarcomas require wide bone resection in order to achieve appropriate margins for cure of disease, and patients undergoing these procedures need durable reconstruction. Biological reconstruction has been shown to provide patients with superior long-term results over other alternatives. Distraction osteogenesis is well studied in the correction of deformities as well as in addressing some congenital musculoskeletal pathologies. The use of this technique in tumor settings has been avoided by many surgeons for a multitude of concerns, including infection risk, potential tumor activation, and uncertainty regarding the effect of systemic therapy on the callus regenerate. We review the use of this reconstruction technique using cases from our institutional experience to illustrate its incorporation into the successful management of orthopedic oncology patients. Distraction osteogenesis is an effective method for reconstructing even large bony defects and is safe in the setting of systemic therapy. This technique has the potential to address some of the common problems associated with orthopedic oncology resection, such as infection and leg length discrepancy.

Post gap arthroplasty transport distraction osteogenesis for reconstruction of neocondyle

Post gap arthroplasty transport distraction osteogenesis for reconstruction of neocondyle

Ultrastructural and element spectrometric analysis of distraction osteogenesis for reconstruction of cleft palate in rhesus macaque model

To study the ultrastructure and Ca/P element spectrometry of distraction osteogenesis (DO) for reconstruction of cleft palate (CP), so as to explore the osteogenesis and remodeling of new bone in situ. 23 rhesus macaques were operated to establish animal models of CP. 2 monkeys didn't received DO as controls. The other 21 monkeys in experimental group underwent DO to correct both bony and soft tissue defects in palate. The distraction was performed at a rate of 0.8 mm/d, twice a day until the cleft was closed. After fixation for 1, 2, 4, 6, 8, 12, 24 weeks, every 3 animals were sacrificed to get the specimens at the distraction gap. The scanning electron microscopic study and Ca, P elements spectrometric analysis were adopted. There were also two unoperated animals as sham group. After fixation for 1-2 weeks, the distraction gap was full of collagen fibers oriented along vector of distraction. Few trabeculae was seen at the margin area. After fixation for 4-6 weeks, active osteogenesis was presented with new formed bone trabeculae and abundant cellular component. After fixation for 8-12 weeks, the new formed bone became mature and couldn't distinguish from the normal bone. 24 weeks later, the bone between the distraction gap had a similar structure to the normal bone. Elements spectrometric analysis results indicated that in early stage of osteogenesis, the P and S peaks were relatively high while the Ca peak was much lower. During the late stage, the S peak was obviously decreased, and Ca/P ratio increased to normal level as in the empty control group. The CP can be corrected by DO. The new bone between the distraction gap is formed and remodeled through intramembraneous osteogenesis.

Two-step transport-disk distraction osteogenesis in reconstruction of mandibular defect involving body and ramus

One-step transport-disk distraction osteogenesis (TDDO) is effective for repairing segmental mandibular defects. The authors studied whether it was effective for reconstructing angled large mandibular defects using a two-step TDDO procedure in seven patients suffering from neoplasm. In the two-step TDDO procedure, the first distraction (horizontal distraction) was initiated immediately after mandibulectomy, aimed at restoring the mandibular body. It was followed by the second distraction, which was obliquely vertical and aimed at restoring the height of the ramus. The distraction rate was set at twice 0.4mm/day. The treatment lasted for 14-18 months. The horizontal distraction length ranged from 48 to 55mm, and the vertical one from 33 to 43mm, with full ossification in the distraction area. No obvious shift of mandible, malocclusion or mouth opening limitation was observed. Patients had a regular diet and spoke clearly. In conclusion, the two-step TDDO is still an option for the reconstruction of large angled mandibular defects when patients are prudently selected, despite the long treatment period required.

Ultrastructural and elemental spectrum analysis of distraction osteogenesis reconstruction for cleft palate on rhesus model

teady of distractor in two set directions: arallel to the Y axis or the extension xis. Thereby, to promote intramembraous ossification, speed up bone formation nd elevate the quality of bone formation. esults: Distractor set parallel to Y axis erformed better than the extension axis. onclusions: This study provides a theretical basis for the position of distract quipment and distraction orientations in linical application. cknowledgement. This study was suported by Scientific and Technologial Development Programme of Jilin rovince Scientific and Technological ureau. NO.20040508

Analysis of genetic regulation and cytokines expressions of distraction osteogenesis reconstruction for cleft palate on rhesus

Background and Objectives: Distraction osteogenesis (DO) is now widely accepted for treatment for bony defects and deformities in craniomaxillofacial region. In this study, the authors applied DO for functional reconstruction of cleft palate (CP) on Rhesus monkeys. Quantitative study of osteopontin (OPN), osteocalcin (OC) in different phases of new bone formation were preformed.

Analysis of genetic regulation and cytokine expression of distraction osteogenesis reconstruction for cleft palate on rhesus. Part I: insulin-like growth factor-I and alkaline phosphatase

Analysis of genetic regulation and cytokine expression of distraction osteogenesis reconstruction for cleft palate on rhesus. Part I: insulin-like growth factor-I and alkaline phosphatase

Distraction Osteogenesis for Temporomandibular Joint Reconstruction

This clinical study evaluated the use of transport distraction osteogenesis in reconstruction of the ramus-condyle unit (RCU) of the temporomandibular joint (TMJ). Thirteen TMJ reconstructions were carried out in 12 patients. Diagnoses included tumors, trauma, ankylosis, and degenerative joint disease. The follow-up period has ranged from 7 to 59 months. Successful distraction was carried out in all cases, with development of solid regenerate bone and an effective new articulation. There were no complications. A good functional level was achieved in all cases. One patient with bilateral rheumatoid arthritis has experienced ongoing degenerative changes in the reconstructed condyles, with reappearance of an anterior open bite. The occlusion has remained stable in all other cases. Distraction osteogenesis is a promising treatment option in reconstruction of the RCU of the TMJ.

Transport Distraction Osteogenesis for Reconstruction of the Ramus-Condyle Unit of the TMJ

Transport Distraction Osteogenesis for Reconstruction of the Ramus-Condyle Unit of the TMJ

Reconstruction of an Intercalary Defect with Bone Transport after Resection of Ewing???s Sarcoma

We report a 13-year-old girl with Ewing's sarcoma of the tibia who was treated with multiagent chemotherapy, followed by local control tumor surgery consisting of wide resection of the tumor and bone transport with distraction osteogenesis for reconstruction. The bone defect created by resection was 13 cm long and was replaced by bone transport using a monolateral external fixator. Evaluation of the resected specimen revealed wide tumor-free margins with 100% chemonecrosis. A planned Harmon-type autogenous bone grafting between the middle and proximal segments of the tibia (docking site) was done primarily after docking occurred, and a solid union was obtained by 23 months after resection. The bone healing index (treatment index) was 54 days/1 cm distraction, which is indicative of slow healing. Clinical evaluation of the affected extremity using the Musculoskeletal Tumor Society rating system revealed 80% normal functional capability. Indications for bone transport in reconstruction of bone defects created by wide resection of bone sarcomas are discussed. In retrospect, we have concerns regarding the suitability of this technique in the setting of diaphyseal sarcoma reconstruction in patients with Ewing's sarcoma who require aggressive and intense multiagent chemotherapy.

A preliminary clinical study of trifocal distraction osteogenesis for reconstruction of segmental mandibular defects

Objective To apply internal trifocal distraction osteogenesis in a canine model of mandibular segmental defects and to study the characteristics of regenerating bone in the functional mandible reconstrction.Methods The internal trifocal distractor was used to reconstruct the mandibular segmental defects of 4 canine model. Mandibular segmental defects in the canine models were established and an internal trifocal distractor was implated at the same time. After 8 days of latency period, trifocal DO was started at a rate of 0.5 mm×2 times per day at each distraction region. The regenerating bone was examined by X-ray and histological method during stages of distraction osteogenesis. Distraction was continued for 15 days. At the end of distraction, the distractor was left in place as an internal fixator for 12 weeks.Results The mandibular defect was successful reconstructed for 30 mm in length of 15 days without any complications. The regenerated bone was confirmed based on the presence of new bone deposit along the mandibular defect by the X-ray, histologic examination, immunohistochemical stain, and scanning electron microscope(SEM). Compression osteosynthesis occured at the region of transport disk union. At 12 weeks after the distraction, the entire regenerate bone was showed near normal in and the morphology and in the density.Conclusion Mandibular segmental defect can be reconstructed successfully by trifocal distraction osteogenesis. The whole gap was filled with new bone and the union of two transport disk was occurred at 12 weeks after the distraction.

Successful management of complications from distraction osteogenesis after osteosarcoma resection: a case report

We report a complicated case of osteosarcoma of the proximal tibia. A 15-year-old boy was referred to us and underwent distraction osteogenesis reconstruction. We administered preoperative chemotherapy for five cycles. Clinical response was determined to be complete by radiography. Marginal excision was then performed with preservation of the proximal tibial epiphysis. Metaphyseal reconstruction (type 2) was performed with distraction osteogenesis. Postoperative chemotherapy also was administered for five cycles. Two years later, the patient developed a deep infection. He underwent curettage and a pedicle peroneal flap transfer, which did not cure the infection. Infected tissues were excised, and shortening-distraction was carried out with the Ilizarov frame. The infection was cured; however, a leg length discrepancy and deformity resulted from frame instability. Four years after the initial operation, the patient fractured his reconstructed leg in a traffic accident. We performed osteosynthesis, deformity correction, and lengthening with the Ilizarov method. We were able to correct the defects using distraction osteogenesis, eventually restoring normal function. Epiphyseal preservation and reconstruction by distraction osteogenesis can provide an excellent outcome, resulting in a stable reconstruction that functionally restores the native limb. Distraction osteogenesis avoids some complications but may involve others, which require detection and appropriate management.