Acute open callus manipulation: Clinical experience with a new surgical technique for solving old problems in distraction osteogenesis.

BACKGROUND:Transport distraction osteogenesis is challenged as a potential alternative to free-flap reconstruction of segmental jaw defects due to its longer treatment time, vector control difficulties, need for additional bone-grafting, and problems creating a curvilinear shape. We propose a new technique of acute open callus manipulation and fixation (AOCMF), which addresses these challenges. METHODS:A retrospective analysis of all patients with jaw defects who underwent DO and AOCMF between 2006 and 2015 was performed. Clinical and demographic data were recorded and analysed. Representative treated cases were presented. RESULTS:Fourteen adult patients were treated, seven for maxillary and seven for mandibular defects of mixed etiology. The mean length of distraction was 4.9 cm (range 3-8 cm). AOCMF was performed between the first and third week of the consolidation phase. Average treatment time was 7.6 weeks (range 4-13 weeks). Mean follow-up was 38 months (range 25-76 months). Stable curvilinear bone shape and soft tissue coverage was achieved in all patients except one. Four complications were recorded. CONCLUSIONS:AOCMF following DO is a safe and reliable technique for reconstruction of segmental defects. It represents a useful alternative to free-flap reconstruction in selected patients. When compared with traditional bone transport techniques, it allows a decrease in the number of surgical procedures and in average treatment time.