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Updated: Aug 24, 2026
Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Amniotic band sequence: the use of bone grafting and distraction osteogenesis
John Kim1, Larry Hollier, Terry Taylor
1Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Distraction osteogenesis successfully reconstructed a severely deficient mandible in a child with amniotic band sequence. This innovative approach created a neomandible, significantly improving the patient's condition.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Orthognathic surgery
Background:
- Severe congenital bone deficiencies, such as those seen in amniotic band sequence, present significant reconstructive challenges.
- Traditional methods like free fibula transfer may be limited by donor site availability or patient condition.
Observation:
- A 5-year-old female with amniotic band sequence presented with transverse deficiencies of all extremities and complete absence of the mandible and overlying soft tissue.
- Due to the patient having only one lower extremity, free fibula transfer was not the preferred option.
Findings:
- Distraction osteogenesis was employed to reconstruct the mandible after preliminary bone grafting to unite the hemimandibles.
- Bilateral distraction of the grafted bone successfully created a neomandible, leading to marked improvement in the patient.
- A pathologic fracture in the mandibular angle region was noted, necessitating further planned distraction.
Implications:
- Distraction osteogenesis offers a viable alternative for mandibular reconstruction in complex pediatric cases with limited donor sites.
- This technique can achieve significant functional and aesthetic improvements in patients with severe craniofacial anomalies.
- Further distraction may be required to address complications like pathologic fractures and optimize outcomes.
Abstract:
Distraction has proven to be a useful technique in cases of severe bone deficiency in the craniofacial skeleton. This is a report of its use in the treatment of a child affected by amniotic band sequence. This 5 year old Hispanic female presented with transverse deficiences of one lower extremity and both upper extremities. Additionally, she was missing the mandible and overlying soft tissue from ramus to ramus. Although free fibula transfer was a possibility, due to the presence of only one lower extremity, it was elected to utilize the technique of distraction. After preliminary bone grafting to unite these two hemimanibles, the bone graft was distracted bilaterally to create a neomandible. Following consolidation and removal of the distraction devices, the child was markedly improved despite what appeared to be a pathologic fracture in the region of the mandibular angle. Repeat distraction was planned.
