Corticotomy.

A correctly performed corticotomy is essential to the success of distraction osteogenesis and prepares for deformity correction, limb lengthening, elimination of bone and soft-tissue defects, reshaping of bones, and treatment of cavitary osteomyelitis. The modern corticotomy has evolved from the initial open osteotomies, which eventually proved to be traumatic to bone's osteogenic elements, and closed bone osteoclasis, which proved time consuming and difficult to control. Ultimately, this led to the combination of an open partial subperiosteal cortical osteotomy, followed by manual osteoclasis of the remainder of the bone cortex. The various types of corticotomy, each with its own special purpose, include transverse or oblique, longitudinal, "splinter," and partial. The techniques and indications for each are outlined. Consideration is given to the latency period--the time from corticotomy to onset of distraction. Morphologic studies have shown that optimally this period should be from seven to ten days. The complications of corticotomy include damage to the osteogenic elements through rough surgical technique, displacement of the fragments after corticotomy, and incomplete corticotomy.