In my searching for the right type of piezoelectric material to be added to the LSJL device, something else I found from the Wikipedia article on piezoelectric material was that piezoelectric materials have been used in surgery.
From the Wikipedia article…
Surgery
A recent application of piezoelectric ultrasound sources is piezoelectric surgery, also known as piezosurgery.[34] Piezosurgery is a minimally invasive technique that aims to cut a target tissue with little damage to neighboring tissues. For example, Hoigne et al.[35] reported its use in hand surgery for the cutting of bone, using frequencies in the range 25–29 kHz, causing microvibrations of 60–210 μm. It has the ability to cut mineralized tissue without cutting neurovascular tissue and other soft tissue, thereby maintaining a blood-free operating area, better visibility and greater precision.[36]
Me: What this seems to suggest is that piezosurgery has been shown to be able to make very precise, small distractions in bones without effecting the muscles or blood vessels around it. At this point the idea is only a thought. However let’s see what other things we can find from google and PubMed…
From the Wikipedia article on Piezosurgery…
Piezoelectric surgery, or piezosurgery in short – is a process that utilizes piezoelectric vibrations in the application of cutting bone tissue. The process was developed by Tomaso Vercellotti [1] and has been patented.[1] It is indicated for use in oral, maxillofacial, cranial and spinal procedures.
By adjusting the ultrasonic frequency of the device, it is possible to cut hard tissue while leaving soft tissue untouched by the process. The ultrasonic frequency is modulated from 10, 30, and 60 cycles/s (Hz) to 29 kHz. The low frequency enables cutting of mineralized structures, not soft tissue. Power can be adjusted from 2.8 to 16 W, with preset power settings for various types of bone density. The tip vibrates within a range of 60–200 µm, which allows clean cutting with precise incisions. A recent article on the topic of piezoelectricity has named Piezoelectric surgery as one of the most important applications of this concept, in addition to the trivial medical ultrasound imaging. [2]
Me: What we are seeing is what I speculated was possible after I did the research on the extracorporeal shock wave therapy. We saw that LIPUS (low intensity pulsed ultrasound) could lead to fracture healing, and that the ESWT has a potential to be better since the frequency was higher. This was what made me wonder what would happen to bone if we just increased further either the intensity (magnitude) or frequency in say sound waves or any type of device that can release vibrations at a high level. It seems that Piezosurgery is exactly what happens. The extremely high frequency of the surgery application causes bone material to easily break apart upon contact. The cuts made are very precise.
From one of the cited articles (source)….
Abstract
Background
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.
Method
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.
Results
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.
Conclusion
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.
Results and discussion
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.
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