Mid-tibial distraction osteogenesis redistributes bone blood flow

Abstract

Background Distraction osteogenesis can be used for the treatment of osteomyelitis and nonunion, conditions thought to benefit from increased blood flow in the bone tissue of the distracted limb. We have questioned whether such an increase occurs, and investigated the spatial distribution of bone blood flow after distraction osteogenesis.Methods The tibiae of 8 rabbits were lengthened 10 mm by a standard mid-tibial distraction osteogenesis procedure. 2 weeks into the consolidation phase, the bone and soft tissue blood flow of the distracted and the contralateral extremity were measured using radioactive microspheres.Results The absolute bone blood flow of the distracted tibia was 4% lower than that of the non-distracted side, representing a 41% decrease in the proximal metaphysis, a smaller decrease in the proximal epiphysis, distal metaphysis and distal epiphysis, and an increase in the diaphysis.Interpretation Mid-tibial distraction osteogenesis redistributed the bone blood flow of the distracted tibia, but absolute tibial blood flow did not increase. Our results do not confirm previous research in this field.

Histological study of the docking site after bone transport. Temporal evolution in a sheep model

“…It is known that the increase in the vascularization in limbs submitted to distraction osteogenesis [26,28,41,43,44] reaches levels up to nine times higher than the contralateral side and that compression over fibrous connective tissue occupying the docking site at the end of distraction induces ischemia. We hypothesize that the ischemia of the fibrous cap stimulates the vascularization, whose increase is also induced by the distraction stimulating the vascular invasion of the docking site.…”