Method Of Distraction Osteogenesis Research Articles

Mandibular reconstruction after excision of recurrent odontogenic keratocyst using a novel mandibular distraction osteogenesis method– a case report

BackgroundOdontogenic keratocyst is one of the most common benign odontogenic neoplasms with a high recurrence rate. Its resection has the potential to lead to mandibular segmental defects. In this case report, we describe a patient with odontogenic keratocyst who underwent radical resection using a novel distraction osteogenesis (DO) method to reconstruct mandibular segmental defect.Case presentationThis case report describes a 19-year-old woman with odontogenic keratocyst of the mandible that recurred after multiple curettages and eventually necessitated radical resection. Mandibular segmental defect after radical resection was reconstructed using a novel DO method that involved directly contacting the segment ends of the defect without the transport disk. However, the distractor broke during the retention period, and a molding titanium plate was used for fixation. This novel distraction method achieved mandibular reconstruction and restored mandibular function and contour.

Congenital pseudoarthrosis of the tibia and fibula is managed with plate osteosynthesis and the Ilizarov method

Pseudo means false, and arthrosis means joint formation. Congenital pseudoarthrosis (C.P.T.) of the tibia is a rare congenital anomaly. The incidence of it is one in 190,000 live births. Although rare, C.P.T. of the tibia poses one of the most challenging management problems in pediatric orthopaedics. It is characterized by de-ossification, bending, and pathological fracture, followed by the inability to form a normal callus at the fracture site. Fifty-five percent of cases of pseudoarthrosis are associated with neurofibromatosis-1 (NF-1), and 6% of patients with NF-1 develop pseudoarthrosis of the tibia. A 9-year-old male came to the orthopaedic outpatient department with a deformity over his right leg since birth. There were multiple café au lait spots on the front and back of the trunk. The right leg had a bony deformity in the lower third with anterior convexity, with typical features of pseudarthrosis tibia and fibula, along with gross abnormal mobility and 2 cm shortening. The left leg was normal. There is no evidence of any new bone formation at the non-union sites. The patient was managed with refreshing the bone ends to produce bleeding bone ends with good contact and open removal of aberrant fibrous tissue from the region of the tibia´s pseudoarthrosis. Bone fragments were reduced and fixed with a locking plate. Corticotomy was done at the proximal end of the tibia to improve the limb length discrepancy via the distraction osteogenesis method, and an Ilizarov ring fixator was applied. Postoperatively, distraction was done at 1 mm per day.

Alveolar distraction osteogenesis: possible complications and methods of their treatment

The aim of the study. Analysis of emerging complications during the method of alveolar distraction osteogenesis in patients with jaw defects. A retrospective analysis of foreign and domestic literature was carried out. A systematic literary search was carried out in the electronic bibliographic databases Web of Science (for foreign articles) and Elibrary and Dissercat (for domestic). In the period from 2005 to 2019 in the clinic of the Department of Maxillofacial and Plastic Surgery of the Moscow State Medical University. Evdokimov conducted an examination and comprehensive treatment of 490 patients with primary and secondary adentia of the upper and lower jaws, accompanied by a significant deficiency of bone tissue of the alveolar ridge vertically. A comprehensive dental rehabilitation of patients with jaw defects by the method of distraction osteogenesis was carried out. The most common complications are: exposure of the fixation modules of the distraction apparatus - 24% of cases, failure of bone regenerate - 13%, inflammatory phenomena - 13%, displacement of the distraction vector - 43%, paresthesia - 7%. Based on our analysis of the identified complications during the distraction osteogenesis method, it was found that these complications are not critical in the treatment of patients with jaw bone deficiency and do not jeopardize the success of rehabilitation. With diagnosis and timely approach to treatment, complications are avoidable.

Biologic Reconstruction With a Motorized Intramedullary Bone Transport Nail After Tumor Resection.

Distraction osteogenesis is an option for reconstruction of intercalary defects. The use of bone transport after tumor surgery has been limited because of concerns of pin tract infections with external fixation and the theoretical risk of causing tumor growth. The effects of chemotherapy and radiation on the regenerate and healing of the docking site are also not well studied, but the current literature has mostly favorable outcomes with no evidence of causing tumor proliferation. The Precice bone transport nail offers a noninvasive method of distraction osteogenesis, which eliminates the need for prolonged external fixation and the risk of pin tract infections. This report discusses the technique for using the Precice bone transport nail after tumor resection. Bone transport may be considered for intercalary defects after en bloc resection of sarcoma, metastatic disease, and benign aggressive bone tumors. The use of distraction osteogenesis after tumor resection is a promising technique for the biologic reconstruction of intercalary defects.

Talo-calcaneal smile osteotomy as a treatment of rigid residual equinus deformity

Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.

The Economics of New Technology

Emerging technologies have been implicated in the steady rise in healthcare expenditures. Although expensive, new technology has allowed for the treatment of very severe deformities within the field of limb lengthening and reconstruction. Beginning as early as the Ilizarov method of distraction osteogenesis, many of the treatments have resulted in impressive clinical results at the cost of being resource intensive. In addition to the economic cost, the treatments placed a significant burden on the patient who was forced to remain in external fixation for long periods of time. To decrease time in external fixation, lengthening over a nail and lengthening and then nailing were developed. Although certainly an improvement, external fixation was still a major component of treatment, and complications associated with its use remained. The advent of the motorized internal lengthening nail (MLN) has obviated the use of external fixation in a select group of patients and seems to be a step forward for the field. Still, the high upfront costs related to the price of the implant have served to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. Although seemingly more expensive, the costs of MLN may be offset by the fact that this treatment requires fewer surgical procedures and may have fewer complications. This article reviews the available evidence with regards to the hospital, surgeon, and total cost when comparing lengthening over a nail versus MLN in the femur and lengthening and then nailing versus MLN in the tibia.

Motorized Internal Limb Lengthening: International Perspectives

The remote-controlled, motorized, intramedullary lengthening nail is a disruptive technology that has fundamentally changed the approach to limb lengthening and reconstruction surgery globally. This new paradigm for limb reconstruction, marked by a decreased need for external fixation, has ignited a fervor among limb deformity surgeons. Although the origins of the Ilizarov method of distraction osteogenesis are deeply entwined with circular external fixation, the disadvantages of external fixators are well known and include pin track infections, skin pain, soft-tissue tethering, and joint stiffness. Integrated fixation techniques were developed combining internal and external fixation such as lengthening over a nail, lengthening and then nailing, lengthening and then plating, and bone transport over a nail to minimize the treatment time in external fixation. Building on these incremental advances, bone lengthening with a fully implantable device has enabled us to entirely avoid external fixation in most cases. Early designs of the internal lengthening nail (ILN) were telescopic and lengthened through a ratchet mechanism requiring mechanical rotation of the limb. Issues with mechanical integrity and accurate control of distraction by these implants have vastly improved over the last decade with the latest remote-controlled ILN delivering a predictable outcome. The remote-controlled ILN is available in different nail types with varied mechanics, material properties, and surgical indications. One design employs an electric motor imbedded into the telescopic rod, activated by intermittent transcutaneous transmission of radiofrequency waves to an implanted antennae/receiver which converts these waves into an electrical impulse discharged via a connecting cable. The second design, now most widely used in the United States, is a telescopic rod with a magnetic drive mechanism, activated by a hand-held external electromagnetic actuator. Furthermore, in addition to the functional mechanism differences, there are nails made from titanium or from stainless steel, and these have different biomechanical properties. The indications range by bone and nail orientation. The femur can be approached antegrade through a piriformis or greater trochanteric entry or can be entered retrograde. A short residual femur after amputation can be lengthened with a specially designed nail. The tibia is approached antegrade. Although the ILNs are primarily used for distraction osteogenesis bone lengthening, the magnetic ILN can also be used for compression of nonunions. In the last several years, there has been some experience with bone transport nails but recently, a motorized magnetic bone transport nail for treatment of segmental bone defects up to 10 cm has been launched, and the early experience is currently being accumulated. Creative, off-label uses of the commercially available nails have included humerus lengthening, retrograde tibia through an ankle/subtalar arthrodesis, extramedullary lengthening with a nail, and bone transport over a plate. Additional internal lengthening designs are in development including humerus nails, ankle fusion/retrograde tibia nails, and internal lengthening plates. In the absence of angular deformity, lengthening of a long bone with the ILN is an ideal surgical indication. Rotation may be corrected over the nail. Blocking screws may be needed to prevent predictable deformities that occur during lengthening. In the presence of preoperative angular deformity, adjuvant techniques such as fixator assisted nailing and blocking screws may be utilized in many, but not all cases, to acutely correct deformity and then gradually lengthen with the ILN. With increased periosteal disruption, latency and distraction may need to be modified. In addition, a staged approach may be used where deformity correction is performed and then at a second surgery, lengthening with the ILN is done. Furthermore, a bifocal approach may be used where deformity correction is performed at one end of the bone and lengthening with the ILN is done at the other end of the bone. The ILNs have created excitement among surgeons from separate sub specialties and diverse nationalities. Both pediatric and adult patients share common pathologies that require bone lengthening and deformity correction including congenital and posttraumatic deformity and leg length discrepancy. These pathologies have inspired global collaboration between orthopedists trained in pediatrics, trauma, foot and ankle, oncology, sports, knee/hip reconstruction, or limb deformity. Through annual meetings and a common body of literature, we all come together to teach and learn from each other. The motorized ILN is an ingenious technology has encouraged us to build new paradigms for limb reconstruction surgery. Although there is continued need for external fixation in selected cases, the modern limb deformity surgeon will use the ILN when possible. The ILN is, however, not available yet in many developing countries. In this edition of Techniques in Orthopedics, dedicated to internal limb lengthening, we have gathered an international panel of experts to discuss specialized applications of this most recent evolution of the Ilizarov method.

Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved.

Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use. To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes. Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded. Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion. The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.

Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis.

Objective:To evaluate the management outcome of complex non-union of femoral fractures with Ilizarov method in terms of bone union, functional results and any complications.Methods:This case series study was carried out at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of three and half years, January 1, 2015 to June 30,2018.Results:There were 50 patients in the study. There were 48(96%) males and 2(4%) females. The ages ranged between 17-54 years with a mean of 33.58±8.9 years. As per ASAMI criteria, the bone results were excellent in 17(34%), good in 30(60%), fair in 1(2%) and poor in 2(4%) patients. The functional results were excellent in 15(30%), good in 24(48%), fair in 8(16%) and poor in 3(6%). The bone union rate was 98% whereas infection eradication rate was 94%. The most frequent complications were pin tract infection affecting 80% patients, knee stiffness 60% patients and K-wires loosening 20% patients.Conclusion:The Ilizarov method provides an effective solution to address the complex non-union of femur fractures. It helps to ensure fracture healing, eradicates infection and provides good functional outcome. The attended complications are mild to moderate and manageable with conservative means.

Distraction osteogenesis on microvascular bone flaps: histological analysis

Despite the high osteoinductive potential of vascularized autograft, being used to close significant jaw defects, the processes of osteoresorpton during remodeling in the oral cavity also affect them. The possibilities of distraction osteogenesis allow to restore the necessary volume of bone's tissue at one stage with minimal traumaticity and predictable result, however it's use on vascularized autografts causes a lot of controversy regarding its effectiveness. There has been held a clinical-experimental study of 60 people with jaw defects with various etiologic factors, which were divided into 2 groups: 1 group with defects without previously made osseous plastic, 2 group with defects partially restored by microvascular autografts. Both groups of patients underwent the method of distraction osteogenesis as pre-implantation preparation. At the stage of dental implantation, histological biopsies were taken from the area of the obtained regenerate, to study and visualize the processes during distraction osteogenesis of micro-vascular autografts. There have been received convincing results about the consistency of the distraction regenerate of both groups and have been revealed the high regenerative potential of microvascular autografts.

Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis

Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas.

Surgical Correction of Hemifacial Microsomia: Simultaneous Orthognathic and Distraction Osteogenesis Treatment. A Case Report on How This Hybrid Technique Can Correct Severe Facial Asymmetries

Hemifacial microsomia (HFM) is one of the most common congenital craniofacial soft and hard tissue deformities, manifesting as a unilateral underdevelopment of anatomical structures arising from the first and second brachial arches. The most salient feature is the underdevelopment of the mandible, particularly the ramus and condyle. Developmental disturbances at various times can lead to numerous presentations in size and function, which might require different treatment options. Conventional therapy for asymmetric patients with severe forms of HFM has been unilateral distraction osteogenesis. However, there has been noted relapse into facial asymmetry due to contraction of the bony segments and a lack of downward growth. With regard to avoiding such complications, we have elected to utilize both the distraction osteogenesis method and traditional orthognathic surgery, allowing us to better control vector movement of the maxillary and mandibular segments. It is our goal that by demonstrating this technique on such an extreme case of HFM, we can show that both methods can be used simultaneously to successfully correct this deformity, whereas each one individually might not have.

Evaluation of inferior alveolar nerve regeneration by bifocal distraction osteogenesis with retrograde transportation of horseradish peroxidase in dogs.

BackgroundBifocal distraction osteogenesis has been shown to be a reliable method for reconstructing segmental mandibular defects. However, there are few reports regarding the occurrence of inferior alveolar nerve regeneration during the process of distraction. Previously, we reported inferior alveolar nerve regeneration after distraction, and evaluated the regenerated nerve using histological and electrophysiological methods. In the present study, we investigated axons regenerated by bifocal distraction osteogenesis using retrograde transportation of horseradish peroxidase in the mandibles of dogs to determine their type and function.Methods and FindingsUsing a bifocal distraction osteogenesis method, we produced a 10-mm mandibular defect, including a nerve defect, in 11 dogs and distracted using a transport disk at a rate of 1 mm/day. The regenerated inferior alveolar nerve was evaluated by retrograde transportation of HRP in all dogs at 3 and 6 months after the first operation. At 3 and 6 months, HRP-labeled neurons were observed in the trigeminal ganglion. The number of HRP-labeled neurons in each section increased, while the cell body diameter of HRP-labeled neurons was reduced over time.ConclusionsWe found that the inferior alveolar nerve after bifocal distraction osteogenesis successfully recovered until peripheral tissue began to function. Although our research is still at the stage of animal experiments, it is considered that it will be possible to apply this method in the future to humans who have the mandibular defects.

Distraction osteogenesis in the treatment of long bone defects of the lower limbs

We carried out a systematic review of the literature to evaluate the evidence regarding the clinical results of the Ilizarov method in the treatment of long bone defects of the lower limbs. Only 37 reports (three non-randomised comparative studies, one prospective study and 33 case-series) met our inclusion criteria. Although several studies were unsatisfactory in terms of statistical heterogeneity, our analysis appears to show that the Ilizarov method of distraction osteogenesis significantly reduced the risk of deep infection in infected osseous lesions (risk ratio 0.14 (95% confidence interval (CI) 0.10 to 0.20), p < 0.001). However, there was a rate of re-fracture of 5% (95% CI 3 to 7), with a rate of neurovascular complications of 2.2% (95% CI 0.3 to 4) and an amputation rate of 2.9% (95% CI 1.4 to 4.4).The data was generally not statistically heterogeneous. Where tibial defects were > 8 cm, the risk of re-fracture increased (odds ratio 3.7 (95% CI 1.1 to 12.5), p = 0.036). The technique is demanding for patients, illustrated by the voluntary amputation rate of 1.6% (95% CI 0 to 3.1), which underlines the need for careful patient selection.

Application of distraction osteogenesis in managing bone cysts

BackgroundDespite the great amount of research concerning bone cysts, there is still no commonly accepted method of treatment. The aim of this study was to evaluate the effectiveness managing bone cyst with hybrid external fixator by distraction osteogenesis.Materials and methodsBetween 1982 and 2009, 25 patients with unicameral (20 patients) and aneurismal (five patients) bone cysts were treated using this method. Eighteen patients had a history of pathological fracture at the same location. Cysts were located in the humerus, femur, tibia, and radius. Median follow-up was 48 (range 31–91) months. Results were evaluated on plain radiographs according to the classification system of Capanna et al. Functional assessment was done using the modified system recommended by Enneking et al.ResultsIn our study group of 25 bone cysts, 15 were classified as completely healed and nine as healed with residual radiolucency. Recurrence was observed in one patient. Absence of response to treatment was not observed. All patients had excellent functional outcomes, except one with recurrence who was rated poor.ConclusionsAs bone cysts are found in long bones in 90–95 % of patients, and taking into account our achieved positive results in almost all patients, we recommend this method of distraction osteogenesis as a treatment option. It is an effective, economical method of treatment, which eliminates deformity and restores bone length, especially in patients with pathologic fractures.

Electrophysiologic Evaluation of Inferior Alveolar Nerve Regenerated by Bifocal Distraction Osteogenesis in Dogs

Bifocal distraction osteogenesis has been shown to be a reliable method for reconstructing missing bone segments. However, there are no reports regarding inferior alveolar nerve regeneration during bifocal distraction. In the present study, the authors evaluated the function of inferior alveolar nerve regenerated by bifocal distraction after segmental resection in the mandibles of dogs. Using a bifocal distraction osteogenesis method, the authors produced a 10-mm mandibular defect and distracted the transport disk at a rate of 1 mm/day. The regenerated inferior alveolar nerve was evaluated by electrophysiologic analysis that was performed on all dogs after euthanasia at 3, 6, and 12 months after the first operation. At 6 and 12 months, stable evoked potential measurements were obtained from the nerves throughout the study on electrophysiologic analyses. The authors' results indicate that the inferior alveolar nerve regenerated by bifocal distraction osteogenesis functioned electrophysiologically at 6 months after the first operation. Although our research is still at the stage of animal experiments, future application in humans is considered to be possible.

Growth factors in human serum during operative tibial lengthening with the ilizarov method

Despite the widespread clinical use of distraction osteogenesis for limb lengthening, the cellular and molecular mechanisms by which this surgical treatment promotes new bone formation in humans are not well understood. The aim of the research was to study the levels of growth factors (GFs) in the serum of patients that were undergoing tibial lengthening with the Ilizarov method of distraction osteogenesis. Those were patients with unilateral congenital discrepancy of the tibia (n = 12), unilateral posttraumatic tibial shortening (n = 7), and healthy patients that underwent cosmetic bilateral tibial lengthening (n = 10). The study established that unlike the congenital group, the posttraumatic group and healthy subjects showed a significantly evident increase in the levels of angiogenic GFs in their serum on day 10 of distraction. In the congenital group, the changes were not significant at this time point. The levels of TGF-α, TGF-β1, and TGF-β2 tended to decrease on day 10 of distraction and on day 30 of the post-distraction period in the cosmetic and posttraumatic groups while they grew in the congenital group. Most dynamic changes in the GFs levels during tibial lengthening were noted in the subjects undergoing cosmetic lengthening, and the least ones were in the congenital group.

Inferior Alveolar Nerve Regeneration After Bifocal Distraction Osteogenesis in Dogs

Bifocal distraction osteogenesis has been shown to be a reliable method for reconstructing missing bone segments. However, no reports have been published regarding inferior alveolar nerve regeneration during this procedure. We assumed that the nerve could regenerate with the bone regeneration during bifocal distraction, if the nerve had been saved at a mesial site of the transport disc. In the present study, we investigated that possibility in dogs. Using a bifocal distraction osteogenesis method, we produced a 10-mm mandibular defect, including the nerve defect, and distracted the transport disc at a rate of 1 mm/day in 12 dogs. The nerve was saved at the mesial site of the transport disc. The regenerated nerve was evaluated by a jaw opening reflex examination performed once daily. Histologic examinations with hematoxylin-eosin and immunohistochemical staining with neurofilament and S-100 antibody were also performed on all dogs after death at 3, 6, and 12 months after the first operation. The jaw opening reflex had recovered in all dogs. The average period of recovery was 109.5 ± 24.7 days. On histologic examination, although consecutive nerves were observed in all areas, cellular nerve fascicles were seen, consistent with wallerian degeneration at 3 and 6 months in the nerve connection area on the distal side of the transport disc. Our results have indicated that inferior alveolar nerve regeneration after bifocal distraction osteogenesis is successful in dogs. Although our research is still at the stage of animal experiments, future application in humans can be considered to be possible.

The Trans-Sutural Distraction Osteogenesis for 22 Cases of Craniosynostosis: A New, Easy, Safe, and Efficient Method in Craniosynostosis Surgery

Background: Distraction osteogenesis for the treatment of craniosynostosis is becoming more widely used as it is simple, there are less transfusions, and a decreased incidence of complications, although a secondary procedure for the removal of the distractors is necessary. However, to date all previous procedures have still been complicated. The authors present a novel trans-sutural distraction osteogenesis method (TSuDO) for the treatment of all types of craniosynostosis. Methods: The TSuDO consisted of simple suturectomy of the pathologic suture followed by direct distraction of the suturectomy site only. Types of TSuDO conducted were sagittal TSuDO in 6 patients, coronal TSuDO in 5 patients, unilateral coronal TSuDO in 8 patients, lambdoid TSuDO in 2 patients, and metopic TSuDO in 1 patient (total = 22). Mean age was 9.3 ± 12.7 months. Results: The mean operation time was 143.6 ± 50.2 min, and mean total transfusion volume of blood components was 131.1 ± 78.3 ml. Immediate correction of the abnormal head contour after distraction was observed in all patients, and no complications were encountered except for 1 patient whose distractor malfunctioned and 2 who showed prolonged discharges from the pin sites (controlled by antibiotics). Conclusion: TSuDO is a simple, effective, and safe method for the treatment of all types of craniosynostosis, and is especially effective for the correction of unilateral coronal craniosynostosis.

Multidirectional Cranial Distraction Osteogenesis for the Treatment of Craniosynostosis

Although many operative methods for the treatment of craniosynostosis exist, whether any difference in outcome could be associated with either the child's age at surgery or the extent of the operation remains to be elucidated. The authors have developed a method of distraction osteogenesis for craniosynostosis that uses a new multidirectional cranial distraction osteogenesis system. From 2003 to 2008, 26 selected patients with syndromic and nonsyndromic craniosynostosis were treated with this method. The ages of the patients ranged from 9 to 139 months (median, 27 months). The follow-up period ranged from 13 to 81 months (median, 49 months). The postoperative course was uneventful in all cases. The mean blood transfusion was 20.9 ml/kg. The mean postoperative hospital stay was 12 days. Sixteen of 49 (32.7 percent) anchor pins used in the first eight patients loosened because of bone absorption during the consolidation period. After the authors altered the screw shape, loosening occurred in seven of 81 pins (8.6 percent) in the last 18 patients. Loosening occurred in 28 of 204 traction pins (13.7 percent) among all patients. The phase of activation ranged from 8 to 14 days (mean, 10.5 days) and the consolidation period ranged from 21 to 42 days (mean, 29 days). Overall, distraction osteogenesis with the multidirectional cranial distraction osteogenesis method is safe and effective. The authors conclude that the multidirectional cranial distraction osteogenesis method constitutes an excellent alternative for all phenotypes of syndromic or nonsyndromic craniosynostosis.