**Author details**

*Clinical Implementation of Bone Regeneration and Maintenance*

to minimize its impact [5].

in human medicine [87].

**Conflict of interest**

regarding the material discussed in the chapter.

children [88].

produce a consistent regenerated bone [84].

During a femoral lengthening, the muscles inserted therein are responsible for the majority of the complication that may occur. The quadriceps, glutes, and abductors can influence the lengthening progression, and the tension exercised on the soft tissues causes pain, reduces the articular mobility, and deforms the regenerated bone column. To achieve a successful lengthening, it is imperative that one understands this concept and adjust the surgical technique and patient management

Stogov and collaborators showed, in dogs, that a high frequency (120 DRy) of 3 mm/day does not only produce viable bone, but also produce compensatory alterations to the muscle tissue that would prevent catabolic alterations on the anterior tibial muscle during a tibia elongation. These authors referred that a high frequency lengthening amount that does not exceed 15% of the initial tibial length, does not result in considerable damage to the anterior tibial muscle. Using a DR of 3 mm/day while increasing the DRy (180 automated distractions per day) can

As mentioned before, the soft tissues are a limitation factor for the procedure [34, 82, 85]. Lengthening exceeding 20% the original bone measure is reported to damage peripheral nerves, muscular, and tendon structures. Thus, physical rehabilitation during the procedures could decrease the severity of the muscular contractures and prevents articular diseases. The double-level or bi-level lengthening, which consist on creating two fracture focus and therefore two focus of bone distraction can reduce by half the distraction period duration, dispersing the distraction forces applied at the soft tissues and reducing the degenerative effects [1]. The correction of biapical radial deformities in dogs has been described with success using bi-level hinged external fixators as posterior distraction [86].

Taking into consideration that the DO can also occur along a transverse axis, perpendicular to the longitudinal bone axis, it is also possible to perform a widening of bone tissue. Some authors have already successfully preformed bone transports, in order to correct a defect on a long bone they perform a DO on the contralateral bone and use the regenerated tissue as graft to the affected limb. It has been performed in the same bone tibia-tibia but also in ipsilateral ulnar and radial bone transports, tibial-humeral and fibular-tibial, and this procedure is also performed

It is worth referring a recent study in humans, which applied a multidirectional

DO device, a new technique with the goal of correcting cranial deformities in

The authors declare no conflict of interest with any financial organization

**102**

Guilherme Domingos1 , Henrique Armés1,2, Isabel Dias3 , Carlos Viegas3 and João Requicha1,3\*

1 Faculty of Veterinary Medicine, University Lusófona, Lisbon, Portugal

2 Hospital Veterinário de São Bento, Lisbon, Portugal

3 Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal

\*Address all correspondence to: jfrequicha@gmail.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
