The Piezosurgery^® Device is ideally sized for hand surgery. The cutting was very precise. The edges of the osteotomy were all sharp to the edge, there was no need to split the bone with a chisel, nor was there the danger of a break out. During the osteotomy there were no disturbing vibrations in the area of operation. This absence of vibration is very practical for operations using a magnifier. Vercellotti mentions that to overcome any problems during surgery, instead of increasing pressure on the hand piece, as in traditional techniques, it is necessary to find the correct pressure to achieve the desired result. With piezoelectric surgery, increasing the working pressure above a certain limit impedes the vibrations of the insert [4]. We have also experienced this in our study. The instrument can be moved in all directions comparable to a pen. The tip of the instrument is exchangeable. Using the fine tip enables multiplanar as well as curved cutting. Because of the automatic water cooling during the whole procedure, there is always a clear view onto the object. This is something oral surgeons found especially useful [6]. The authors mention that the downside of the device is the relative slow sawing process. We needed about 30 seconds for one cut of the relatively small bone. This is about 20 seconds longer than the time needed for cutting with the usual saw. Although the power can be regulated with the power box and the use of different scalpels, we agree with other authors that the optimal use of this device is in surgeries of small bones where precise and soft tissue friendly cutting is required [7]. As other literature has shown, the device selectively cuts bone while sparing nerves and other soft tissue [2,3]. This allows for minimal invasive surgeries with limited retraction of soft tissue and minimal stripping of the periosteum, saves time and might have a positive effect on the healing process. Our aim of the first time use of the Piezosurgery^® Device in hand surgery was to check its usability in osteotomies of tubular bones. The preparation of the bone was done in the usual manner as is done when cutting with an oscillating saw. The reason for this was to fully visualize the cutting process using this new device, although in the future, it should be possible to minimize the bony exposure. In our patient the postoperative healing of the wound and the bone consolidation (Figure 4) were smooth. The duration of postoperative sick leave was four weeks which is more rapid than the usual recovery period. The patient regained full use of his finger according to the state before the fracture. At no point was there any loss of sensitivity. The patient as well as the surgeons were fully satisfied with the result.

Me: From this PubMed study HERE, the surgeon states ..”The principle of piezosurgery is ultrasonic transduction, obtained by piezoelectric ceramic contraction and expansion. The vibrations thus obtained are amplified and transferred onto the insert of a drill which, when rapidly applied, with slight pressure, upon the bony tissue, results, in the presence of irrigation with physiological solution, in the cavitation phenomenon, with a mechanical cutting effect, exclusively on mineralized tissues.”

I always stated that I would look for a solution to height increase that was NOT just only non-invasive but invasive as well. However the idea was always to look for a minimal invasive procedure or method. One of the biggest points I always emphasized was that the hard bones either had to be distracted or demineralized so that the overall structure can be stretched out easily. The piezosurgery seems to allow surgeons to make very precise cuts in the bone. I remember that to do the distraction osteogenesis the surgeon takes a hammer and chisel and just swings to crack the outer layer of bone in the lengthening bone. If we saw an X-ray of the bones, we’d see that the induced fracture is not clean or orderly. This method for surgery would allow for specified distraction forms and shapes. This means that we can theoreticaly use it to first open up bones at the right amount of distraction shape and thickness and then get our full sized plate shaped grown growth plates (which I proved in a previous post) and implant them into the properly created distractions thus completing the growth plate transplant process.

Note: This idea is definitely a field I wanted to do more research on so I decided to state that this post is just the first part of many.