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Under appropriate conditions, bone responds to gradual mechanical distraction with new bone formation, termed distraction osteogenesis. Additional effects on the surrounding soft tissues result in phenomena known as distraction histogenesis. Use of this method, pioneered by Ilizarov, has resulted in the successful management of conditions previously considered difficult, dangerous, or impossible to treat. Research has defined many of the mechanical and biologic parameters critical to optimal bone regeneration. Additional efforts are currently underway to determine the molecular mechanisms involved. The effects of distraction on soft tissue are discussed in the recent literature, including the response of muscles, nerves, and cartilage.