Soft Tissue Distraction Research Articles

Distraction with external fixator for contractures of proximal interphalangeal joints: good outcome in 10 cases.

We present a new and simple technique for the treatment of proximal interphalangeal (PIP) joint contractures by mini Orthofix external fixator without open surgery. The technique was tested on 10 patients. We found that the fixator is easy to apply and effective in reducing contractures of the PIP joint by soft tissue distraction.

New Techniques in the Operative Treatment of Congenital Malformations of the Hand and Forearm

Background: The rapid development of hand surgery in general has influenced the treatment of congenital malformations of the hand and forearm. Methods: The current indications and techniques for reconstruction of congenital malformations of the hand and forearm are reviewed. Results: Of the new techniques in the operative treatment of congenital malformations of the hand and forearm, the microsurgical procedures have to be mentioned first. The use of vascularized transplantation of toe and toe joints to thumb and fingers as well as the treatment methods for proximal radioulnar synostosis and congenital forearm pseudarthrosis have special indications. The different procedures of callus distraction, distraction transposition, and transverse soft-tissue distraction facilitating the separation of narrow syndactylies have to be known. Syndactyly separation without skin grafts must be discussed critically. Conclusions: Congenital malformations of the hand and forearm are rare. Knowledge of the optimal corrective techniques and experience are mandatory to improve functional long-term results.

Notes on the practicalities of circular frame treatment for limb lengthening and deformity correction in children

This article describes one hospital team’s experience of limb lengthening and deformity correction using the Ilizarov technique of gradual distraction of soft tissues and bone. Some of the practical issues, which need to be considered by the multidisciplinary team involved in such patients’ care are explained as the surgical skills are only part of such a treatment method.

Re: LeFort I Soft Tissue Distraction: A Hybrid Technique. Wong GB and Padwa BL. J Craniofac Surg 2002, 13: 572–576.

Re: LeFort I Soft Tissue Distraction: A Hybrid Technique. Wong GB and Padwa BL. J Craniofac Surg 2002, 13: 572–576.

Preoperative Intermittent Pneumatic Soft-Tissue Distraction in Patients with severe Dupuytren's Contracture

Evaluation of the outcome of preoperative intermittent pneumatic soft tissue distraction (IPD) in patients with severe contractures in Dupuytren's disease with special regards on recurrent deformities. In a prospective study, nine patients with Dupuytren's contracture grade III and IV according to the classification of Tubiana were treated with a preoperative intermittent soft-tissue distraction using a pneumatic extension device followed by a standardized operative correction and follow-up program. Sixteen fingers were involved: grade I and II four fingers, grade III and IV twelve fingers. Nine fingers - grade III and IV seven fingers - in six patients had a recurrent deformity. The preoperative reduction of contracture simplifies the surgical treatment. Preoperatively using the IPD, the flexion contracture was reduced between 5 and 60 degrees. With an average of 29 (10 to 60) degrees, the improvement was greater in fingers with severe contracture (grade III and IV according to Tubiana) than in fingers with a minor contracture averaging 10 (5 to 25) degrees. In fingers with recurrent deformity, the reduction of the flexion contracture averaged 27 (5 to 60) degrees. There were no complications leading to break off of the distraction. The intermittent pneumatic distraction is a good alternative to the method introduced by Messina for preoperative soft-tissue distraction in patients with severe Dupuytren's contracture.

Presentation of a simple method of preoperative soft-tissue distraction in Dupuytren's contracture grade IV

We describe a technique of continuous preoperative soft-tissue distraction in Dupuytren's contracture grade IV using an unilateral external fixator which is simple to apply. The operative technique and the result are demonstrated.

Distraction and microvascular epiphysis transfer for radial club hand

This paper presents a different technique of treatment for Bayne type IV radial club hand using a microvascular joint transfer in order to reconstruct the absent half of the wrist joint, aiming for better movement and stability at the wrist joint with preservation of longitudinal growth. The method uses preoperative soft tissue distraction to obtain proper alignment of the hand on the ulna before the second metatarsophalangeal joint with the whole metatarsal bone is transplanted. The treatment takes about 4 months and the optimum period for surgery is during the second year of life. Pollicization is added later in the normal manner. The new technique has been used in 12 cases by the author since 1987 and the results of the first nine cases are reported with a mean follow-up of 6 years. This technique appears to be promising but is demanding because of the microvascular joint transplantation at an early age.

Ilizarov distraction-lengthening in congenital anomalies of the upper limb

Nine patients underwent Ilizarov distraction-lengthening for congenital anomalies. All were late cases and had undergone other procedures. In five radial club hand patients with very short forearms, we achieved an average 5.8 cm increase in length with each distraction cycle. In two patients with symbrachydactyly of the cleft hand type, we achieved pinch grip between a radial and an ulnar digit by lengthening the short ray. Another case of the monodactyly type in which we tried to lengthen three transplanted proximal toe phalanges ended in failure. A soft tissue distraction was attempted in a case of camptodactyly but failed. We report the problems we encountered and suggest some solutions.

Measurement of bone lengthening forces; an experimental model in the lamb

Objective. To obtain the mechanical behaviour pattern of the lengthening process. Design. In vivo measurement of forces during bone lengthening in lambs. Background. A series of parameters of a mechanical and biological nature have a bearing on all lengthening processes, and most of them are not fully understood. Methods. A strain-gauge-monitored unilateral fixator was designed and used to obtain data about the changes which took place in the forces of elongation at a rate of 1 mm/day in four lambs while a 3 cm progressive lengthening of the left tibia was being performed, analysing how these forces behaved from day to day, and how they changed in the course of a single day. Results. The maximum forces in all the animals each day occur after distraction, and the forces reach their greatest magnitude between days 21 and 25 after surgery, attaining values of slightly over 8 kg (40–50% of the animal's weight). The maximum daily force starts to drop 1 h after distraction, and continues to decrease gradually throughout the day until it reaches a value slightly greater than the initial force on the previous day. Conclusion. This pattern is due to the distraction of soft tissues which gradually adapt to their new situation, thereby reducing the level of stress.

Preliminary soft tissue distraction in congenital forearm deficiency

Four patients (five limbs) were treated with preliminary soft tissue distraction using an Orthofix external distractor. The patient's ages ranged from 6 months to 14 years. Forearm deficiencies treated included partial absence of the radius (one patient), radial aplasia (two patients, three limbs), and partial absence of the ulna (one patient). Soft tissue distraction (mean, 55 days) was continued in radial deficiency until the hand could be passively centralized without residual radial deviation, allowing centralization to be accomplished through a single mid-dorsal incision. Mean measurement of distraction for the radial deficiencies was 1 cm. In the ulnar deficiency, soft tissue distraction was carried out until the cut radius was distal to the partially absent ulna (98 days) allowing for the creation of a one-bone forearm using the entire radius. Distraction (1 mm/day) was done by the children's parents with no distractor removed because of patient intolerance. All radial deficiency limbs remained centralized at a mean followup period of 14 months.

Skeletal distraction of the hypoplastic mandible.

Six patients underwent percutaneous pin placement, 17 intraoral corticotomies, and application of an Orthofix lengthening device to facilitate complex multiplanar distraction as mandated by the patient's specific deformity. The patients underwent gradual bony and soft-tissue distraction at the rate of .25 mm four times a day. Average distraction was 18.3 +/- 5.5 mm (mean +/- SD). After distraction, a 2-day period of stabilization for each 1 mm of lengthening was used (36.4 +/- 10.7 days) (M +/- SD). All the patients had marked improvement in their occlusion postoperatively and significant amelioration of their preoperative respiratory and feeding difficulties. The patients all exhibited dramatic aesthetic improvement. Intraoral corticotomies performed in conjunction with gradual skeletal distraction appears to offer significant advantages over classical treatment for micrognathia in a very specific group of patients.

Reconstruction of the humerus by soft tissue distraction and vascularized fibula transfer

We report a case of reconstruction of the humeral shaft by soft tissue lengthening according to the method of Ilizarov, followed by skeletal reconstruction with a vascularized fibular graft. Skeletal union and initiation of functional activity were achieved within 4 months. Lengthening of the soft tissue and the vascular tree by slow distraction did not compromise the subsequent reconstructive microsurgical procedure.

Arthroscopic ankle arthrodesis utilizing a soft tissue distraction technique: James P. Tasto. San Diego, California, U.S.A.

Arthroscopic ankle arthrodesis utilizing a soft tissue distraction technique: James P. Tasto. San Diego, California, U.S.A.

Ilizarov Technique in Correction of Foot Deformities: A Preliminary Report

Four deformed feet in three patients were corrected completely using the new limited intervention technique of Ilizarov. One foot in the younger patient was corrected by soft tissue distraction only. In three feet in the older patients V osteotomies were needed to initiate the distraction. Two complications occurred: herpes simplex infected two of the osteotomy sites, which were treated successfully with local treatment. The detailed method and indications are outlined.

Stress tolerance of patients following fractures of the lower extremities

In bone fractures in the lower extremities a high blood loss must be taken into consideration. An adequate blood transfusion should be given before and during diagnostic procedures. Diagnostic measures should proceed quickly and be limited to the necessary treatment. Operative setting of closed fractures can be programmed when conditions are optimal. Immediate setting of open fractures has proven to be valuable not only because the blood loss may be controlled, but also because extensive soft tissue distraction and possible infection can be prevented. The crush-syndrome can be caused by crushing injuries, pluck-out injuries and traumatic amputation and endanger the patient's life.