Distraction Osteogenesis in Plastic Surgery

Distraction osteogenesis (DO), the gradual controlled movement of osteotomized bone to create native bone de novo, is a powerful tool in the reconstructive surgeon’s armamentarium. Originally developed by Ilizarov in the early twentieth century in Russia for use on the long bones of the leg, Snyder, McCarth, and other craniofacial pioneers popularized the technique in the well-vascularized bones of the facial skeleton. DO involves making a planned osteotomy perpendicular to the desired vector of skeletal growth and then applying incremental traction across this opening to encourage the growth of new osteogenic matrix. With adequate stabilization, this bony regenerate becomes ossified and remodels into a new bone. Although the original studies used distraction n the mandible, applications can now be found in the maxilla, midface, and cranial vault. Established bony flaps or grafts can also be distracted to allow for more creative solutions. In the past few decades, device technology has rapidly advanced with new simplified external devices and smaller buried internal distraction devices. In the absence of adequate bone stock, distraction offers a unique opportunity to create new bon