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Piezoelectric osteotomy in hand surgery: first experiences with a new technique
- Dominik J Hoigne1Email author,
- Stefan Stübinger†2,
- Oliver Von Kaenel†3,
- Sonia Shamdasani1 and
- Paula Hasenboehler4
© Hoigne et al; licensee BioMed Central Ltd. 2006
Received: 22 August 2005
Accepted: 12 April 2006
Published: 12 April 2006
In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery.
While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery® Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year.
The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances.
The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery.
For osteotomies of the hand oscillating saws are usually used . Even though they are varied in size, they are not very precise for use in the vicinity of nerves and arteries. They also pose problems while being used in conjunction with magnification, as one's range of sight and focus is restricted when wearing magnifying glasses. For that reason oral surgeons have moved to using the newly developed piezoelectrical bone scalpel when operating in the near vicinity of nerves or arteries. The tip of this instrument oscillates in the frequency of ultrasound . The mechanism of this device is based on the so called Piezo – Effect. French Physicists Jean and Marie Curie first mentioned the direct Piezo-Effect 1880, whereby certain crystals produce electrical current while under mechanical pressure. The reciprocal effect, by which the crystals are deformed when under electrical current, was then discovered a while later. This is the effect being used by the Piezosurgery Device®. In this device, the electrical field is located in the handle of the saw . Due to the deformation caused by the electrical current, a cutting – hammering movement is produced at the tip of the instrument. These micro movements are in the frequency range of 25 to 29 kHz and, depending on the insert, with an amplitude of 60 to 210 μm. This way only mineralized tissue is selectively cut. Neurovascular tissue and other soft tissue would only be cut by a frequency of above 50 kHz [3–5]. Depending on the strength of the bone and the blade geometry, the efficiency of the cutting can be regulated by the frequency modulator and the power level. For cooling there is an integrated pump with five different working levels. This pump automatically washes physiological solution to the area being cut. The cost of the device is about 7.000 USD. Additional costs per operation are for the cooling liquid and are in the range of a few dollars. We have used the Piezosurgery Device® by Mectron [Italy]  for the first time in osteotomies of the long bone in the field of hand surgery. We will report on our experience with one case, with a follow up time of one year.
Results and discussion
The Piezosurgery® Device is a useful device for small long bone osteotomies. We feel that this device has great potential in the field of hand- and spinal surgery. As the device selectively cuts bone, considerable nerve lesions can be avoided and minimal invasive surgeries are possible. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques.
We obtained oral consent from the patient but could not obtain written consent.
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