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Issue Date: March 2007


Top Docs Distraction Length


LVW
It took eight years and about half a dozen surgeries throughout his early childhood, but today at age 23, Dave Cancilliere can grip a pen and play baseball and basketball. Born with only two fused fingers on his right hand, and three fingers on his left, Cancilliere was one of the first toddlers to undergo a procedure known as distraction lengthening.
Today, he has a fully functioning finger and thumb on his right hand, and the three fingers on his left hand are all at a sufficient length to accomplish nearly any task this Cuyahoga Community College political science student wants.

Dr. William H. Seitz Jr., clinical professor of surgery in the department of orthopaedic surgery at Cleveland Clinic, has been developing a distraction lengthening procedure called callotasis since 1986. Having performed about 600 of these procedures in the past 20 years, Seitz has treated people from the United States and around the world.
Finger bones can be coaxed to grow by transplanting either section of bones from the base of a pa-tient’s second and third toes, or in some cases, entire toes, and attaching them to what bones may be available in a patient’s hands. Tiny pins are threaded through the bones. Seitz then carefully cuts the bone between the pins to create a controlled fracture. The soft tissue is sutured back with its blood supply around the bones and is then affixed to a Microfix lengthener, a device Seitz designed to help hold the bones, screws and threads in place. Usually, four screws — two on either side of the bone di-vision being lengthened — are gently turned. 
Often the toes from where the bone is removed aren’t drastically affected. However, in cases such as Cancilliere’s, patients must learn how to walk without the toe. 
The procedure is a long-term commitment for patients and their families, often taking several months with the possibility of repeat surgeries. Parents of a young child must turn tiny screws that force their baby’s bones to grow a fourth of a millimeter, four times a day, with a goal of one millime-ter per day. The bone is actually fractured, allowed to heal, and then disturbed over and over. This pat-tern of distraction and stability creates stem cells in the bones, which leads to growth. 

“It’s a gentle lengthening,” says Seitz. “The child can use the hand during the healing process. Once it’s at the desired length, we just have to wait and let the bone heal.”

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