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Faber J, Linz C, Böhm H, Kunz F, Schweitzer T. Stable fixation using absorbable sutures in craniofacial surgery in patients over 24 months of age-a retrospective study. Childs Nerv Syst 2024; 40:2545-2550. [PMID: 38587625 PMCID: PMC11269337 DOI: 10.1007/s00381-024-06377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In craniofacial surgery, the stable fixation of transposed bone segments is crucial in order to ensure good long-term results. The use of absorbable material in fixation avoids the need for a second surgery, which would otherwise be required to remove osteosynthesis material. The authors of the present manuscript have already demonstrated that absorbable sutures ensure the stable fixation of bone segments in patients up to 24 months of age. However, it has thus far remained unclear whether stable fixation is possible in older patients by using only absorbable sutures due to the slower bone remodelling and prolonged healing time in this cohort. METHOD For the present study, osteosynthesis was performed in 50 patients ranging from 25.7 to 192.1 months of age (mean, 61.4 ± 21.7 months) using solely absorbable sutures (PDS II®, Ethicon, Germany). Post-operative stability and possible restrictions-such as foreign body reactions-were evaluated within clinical and radiological routine follow-ups. RESULTS All children demonstrated clinically and radiologically stable osteosynthesis both directly post-operatively and in follow-ups. No significant foreign body reaction could be seen. CONCLUSION The present study demonstrates-for the first time-that absorbable sutures with a longer absorption period are also very well suited for the fixation of bone segments in patients over 24 months of age. The sole use of absorbable sutures in children over 24 months of age is a safe procedure with nearly no foreign body reactions. The procedure enables stable and highly cost-effective osteosynthesis without altering the osteotomy design.
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Affiliation(s)
- Julian Faber
- Department for Oral and Craniomaxillofacial Plastic Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Christian Linz
- Department for Oral and Craniomaxillofacial Plastic Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Hartmut Böhm
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Felix Kunz
- Department of Orthodontics, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Tilmann Schweitzer
- Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 2, 97070, Würzburg, Germany
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Linkugel AD, Markiewicz MR, Edwards S, Susarla SM. Conceptual Principles in Pediatric Craniomaxillofacial Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:411-424. [PMID: 38705817 DOI: 10.1016/j.coms.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Pediatric craniomaxillofacial reconstruction must be approached through the lens of growth and durability. A systematic approach of matching defects to donor tissue drives the selection of autologous reconstructive technique. The menu of available methods for reconstruction can be organized in a manner similar to adults, with special considerations for growth and development. Reconstructive surgeons have the opprtunity to promote and maintain young patients' sense of identity during psychosocial development.
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Affiliation(s)
- Andrew D Linkugel
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo School of Dental Medicine, 3435 Main Street, 112 Squire Hall, Buffalo NY 14214, USA
| | - Sean Edwards
- Department of Oral & Maxillofacial Surgery, University of Michigan School of Dentistry, 2200 Vinewood Boulevard, Ann Arbor, MI 48104, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA.
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Three-Dimensional Printed Polycaprolactone Mesh in Pediatric Cranial Vault Remodeling Surgery. J Craniofac Surg 2022:00001665-990000000-00486. [PMID: 36730495 DOI: 10.1097/scs.0000000000009133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The surgical management of craniosynostosis has greatly evolved with improvements in both technology and understanding of the disease process. Some drawbacks remain regarding bone regeneration within the surgical bony gaps. Generally, bony gaps improve in the 12 to 24 months after surgery, but some gaps may remain for longer and cause deformity and/or require additional bony reconstruction. These considerations make tissue-engineered bone very attractive. Novel 3-dimensional printed bioresorbable mesh implants made of Polycaprolactone (PCL) can be used to fill the surgical bony defects. OBJECTIVES The authors seek to investigate how the use of a 3-dimensional printed biodegradable PCL mesh applied to bony defects in cranial vault surgery affects bone healing. METHODS Case series analysis of 8 pediatric patients who have undergone surgical intervention using PCL mesh implants for reconstruction of bony defects during craniosynostosis correction surgery. FINDINGS Radiological evaluation of 3 patients at random time points between 9 and 12 months postoperative revealed persistent bony gaps in areas where PCL mesh was laid. One patient who underwent a subsequent cranial vault surgery at 9 months was found to have less bone regeneration in the defect area where PCL mesh was used when compared with an adjacent area where a particulate bone graft was used. CONCLUSIONS Based on our experience, the use of PCL mesh on its own did not augment bone regeneration. It is possible that a greater amount of time or increased vascularization of the scaffold is required, which supports the concept of regenerative matching axial vascularization or the further addition of osteogenic factors to increase the rate of bone formation.
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Ros B, Iglesias S, Selfa A, Ruiz F, Arráez MÁ. Conventional posterior cranial vault expansion: indications and results-review of the literature. Childs Nerv Syst 2021; 37:3149-3175. [PMID: 34604916 DOI: 10.1007/s00381-021-05318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
In the late 1980s, craniofacial surgery units reported suboptimal cosmetic results, cranial volume restriction, and intracranial hypertension after anterior cranial vault remodeling in bilateral coronal synostosis associated with severe brachyturricephaly. A possible explanation was a severe associated growth restriction of the posterior calvaria with radiological synostosis at the lambda sutures. "Conventional" or "fixed" posterior cranial vault expansion techniques were developed to address these limitations, sometimes as the first surgical step in a two-staged protocol of total calvarial reconstruction, combined with suboccipital decompression in cases of symptomatic cerebellar tonsillar herniation or, more easily, to resolve the characteristic occipital flattening of lambdoid synostosis. Various surgical approaches have been described; however, the indications for and timing of surgical treatment and postoperative evaluation of results still remain controversial. Although more invasive, conventional posterior cranial vault expansion has proven to be safe and offers a remodeled and protective bony vault immediately after surgery, but the underlying cranial base malformation remained untreated, with implications in the postoperative growth of the facial skeleton. Overcorrection, rigid stabilization, and grafting are also concerns to be addressed.
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Affiliation(s)
- Bienvenido Ros
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain.
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain.
| | - Sara Iglesias
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Antonio Selfa
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Francisco Ruiz
- Department of Maxillofacial Surgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Miguel Ángel Arráez
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
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Examining the Relationship Between Wound Complications and the Use of Resorbable Plates in Cranial Vault Reconstruction. J Craniofac Surg 2021; 32:2310-2313. [PMID: 34705379 DOI: 10.1097/scs.0000000000007663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Resorbable plates are commonly used in cranial vault reconstruction surgery. There are few published papers examining their safety profile. The authors examined the prevalence of wound complications associated with the use of resorbable plates (Inion CPS Fixation System) in pediatric patients undergoing cranial vault reconstruction. METHODS A retrospective review of patients (n = 182) who underwent cranial vault reconstruction using resorbable plate fixation was undertaken. All procedures were performed by a single Craniofacial Surgeon at the National Pediatric Craniofacial Center from 2008 to 2016. Wound complications were identified from a prospectively maintained database and medical note review. Several key patient characteristics and surgical variables were also recorded and tested for associations with wound complications. RESULTS A total of 58.8% (107 of 182) of patients were male with a median age at surgery of 16.2 months. Overall, 12.1% (22 of 182) experienced a postoperative wound complication requiring hospital admission. A total of 2.73% (5 of 182) of the patients that returned to theatre had remnants of plates removed. The authors had a mean time from primary operation to secondary reoperation of 103 days. In univariate statistical analysis, females were more likely to develop a wound complication. However, in stratified analyses excluding patients with an underlying genetic syndrome, increasing age, and lower weight but not gender were associated with wound complications. CONCLUSIONS A 12.1% (22 of 182) wound complication rate with the use of the Inion CPS Fixation System was observed. Inion plates appear to have an equivalent safety profile to other fixation devices. Increasing age and lower weight were associated with an increased risk of wound complications in nonsyndromic patients.
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Bioabsorbable System-Related Subcutaneous Swelling After Craniofacial Surgery. J Craniofac Surg 2021; 32:e816-e818. [PMID: 34238875 DOI: 10.1097/scs.0000000000007869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Bioabsorbable systems have been commonly used in pediatric patients for primary cranioplasty and other related surgeries. However, subcutaneous swelling, a unique complication related to bioabsorbable osteosynthesis, is a concern. Differences in the incidence of subcutaneous swelling, depending on the bioabsorbable material used to construct the plate, are still unknown. METHODS The authors retrospectively reviewed all incidences of subcutaneous swelling related to resorbable systems used during primary cranioplasty for patients with craniosynostosis at their hospital between 2014 and 2018 during a 12-month follow-up period. Furthermore, the authors reviewed all published English-language articles (since 1995) on subcutaneous swelling in bioabsorbable systems used for craniosynostosis. RESULTS The most common resorbable systems used in the literature were divided into 2 groups: mixtures of poly D-lactic acid and polyglycolic acid, and mixtures of poly D- and L-lactic acid. In patients for whom poly D-lactic acid and polyglycolic acid were used, the incidence of subcutaneous swelling during resorption was 0% to 4.2% between 3 and 9 months of follow-up. In patients for whom poly D- and L-lactic acid was used, subcutaneous swelling during resorption occurred in 5% to 16.7% of these patients between 6 and 12 months of follow-up. All cases resolved spontaneously after complete absorption of the plate. CONCLUSIONS It was difficult to determine which system had the lowest incidence of subcutaneous swelling. The thickness of each resorbable system and the thickness of the infants' scalps were different in each study. However, subcutaneous swelling occurred in every resorbable system. Therefore, preoperative counseling and careful follow-up are necessary.
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Calloni T, Trezza A, Mazzoleni F, Cavaliere M, Canonico F, Sganzerla E, Giussani C. Infant ossified cephalohematoma: a review of the surgical management and technical update. J Neurosurg Sci 2021; 64:552-557. [PMID: 33463977 DOI: 10.23736/s0390-5616.20.05052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cephalohematoma is a subperiosteal collection of blood above the skull. It is associated with operative and prolonged deliveries. In most cases the hematoma spontaneously resolves in a short span of time, usually within one month. In a few cases cephalohematoma can become ossified and require surgical treatment. Traditional belief that ossified cephalohematomas are an exclusively cosmetic issue has been called into question by recent description of EEG anomalies associated to a calcified cephalohematoma. We review relevant surgical literature, and we describe a novel variant of Wong's Radial Cap technique by foregoing healthy bone margin removal, removing the cephalohematoma lamellae in a stepwise fashion and using resorbable plaques for fixation. We furthermore review the rationale, timing and step-by-step execution of the procedure. An exemplary case description is discussed.
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Affiliation(s)
- Tommaso Calloni
- School of Medicine, University of Milano-Bicocca, Milan, Italy - .,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy -
| | - Andrea Trezza
- Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Fabio Mazzoleni
- Unit of Maxillo-Facial Surgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Marilou Cavaliere
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Francesco Canonico
- Unit of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Erik Sganzerla
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Carlo Giussani
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
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Yasuhara T, Murai S, Mikuni N, Miyamoto S, Date I. Japanese National Questionnaire Survey in 2018 on Complications Related to Cranial Implants in Neurosurgery. Neurol Med Chir (Tokyo) 2020; 60:337-350. [PMID: 32536658 PMCID: PMC7358783 DOI: 10.2176/nmc.oa.2020-0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cranial implants are commonly used throughout the world, yet the data on
complications remain partly clarified. The aim of this study was to gather real
data in 2018 on complications related to cranial implants in neurosurgery. The
survey population consisted of 1103 institutes supplying neurosurgical
treatment. The survey consisted of two-stage questionnaire. First the incidence
of complications was investigated, then the secondary questionnaire was e-mailed
to the respondents about the detailed of the complications. As the result, the
annual incidence of complications related to cranial implants was 0.558% in
Japan. Titanium plate and mesh were used predominantly in craniotomy and
cranioplasty, respectively. The second survey collected data on 449 cases with
complications (infection: 63%, implant exposure: 46%, multiple answer).
Postoperative infection was associated with male sex, brain tumor, short
interval between surgery and complication, usage of ceramics, hydroxyapatite,
resin, and artificial dura, hyponutrition, multiple surgeries, dirty wound, and
sinusitis as patient factors, and CSF leakage, ruptured sutures, and sinus
maltreatment as surgery factors. Meanwhile, long hospital stay was associated
with age, male sex, mRS 3–5 before complication, short interval between
initial surgery and complication, large craniotomy, long operative time, usage
of ceramics and artificial dura, multiple surgeries and dirty wound as patient
factors, ruptured suture as a surgical factor, and bacterial infection,
especially MRSA infection, as the complication and treatment consisting of
removal as complication factors. In conclusion, this is the first Japanese
national survey on complications related to cranial implants in neurosurgery. It
is important to recall that complications may arise years after surgery and to
be aware of the risk factors associated with complications.
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Affiliation(s)
- Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | | | | | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system: A prospective report with a minimum follow-up of 30 months. J Plast Reconstr Aesthet Surg 2019; 73:586-589. [PMID: 31735426 DOI: 10.1016/j.bjps.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 11/23/2022]
Abstract
Several resorbable fixation systems are used for osteosynthesis in craniofacial surgery. Recently, ultrasonic-assisted pinned resorbable systems have been introduced; however, few studies have described the associated complications during the long-term follow-up until complete resorption. In this study, we investigated the complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system with a follow-up of at least 30 months. Among patients who underwent craniofacial surgery using a commercially available ultrasonic-assisted pinned resorbable system between 2014 and 2016, those with follow-up visits for at least 30 months were included in this study. We investigated the development of complications such as local infection, exposure of the device, and reoperation related to the implant. Twenty-four patients aged 6 months to 69.4 years (median: 3.5 years) were followed up for more than 30 months. None of the patients required reoperation regardless of implants. Further, no infection or device exposure was seen among all patients. However, two patients aged 6 and 22 months who underwent cranioplasty for craniosynostosis and another patient aged 148 months who underwent cranioplasty for cranial defect exhibited plate-related bulging in the scalp during the course of resorption between 7 and 12 months of follow-up. The bulges were characterized by swelling without pain or redness and resolved spontaneously within 18 months of follow-up, which was considered to occur after complete absorption of the plate. In conclusion, subcutaneous swelling is related to resorbable plates and has a benign clinical course. We recommend that patients be informed of this phenomenon preoperatively to relieve their anxiety.
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Wound Healing Complications After Cranial Vault Reconstruction for Craniosynostosis. J Craniofac Surg 2019; 31:110-112. [PMID: 31652214 DOI: 10.1097/scs.0000000000005937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniosynostosis is a congenital cranial malformation involving premature fusion of cranial sutures. Indications for surgical repair of craniosynostosis include elevation of intracranial pressure, which can result in impaired vision and mental disability, as well as correction of abnormal skull shape. Resorbable plating systems have become the preferred technique for bony fixation in the repair of craniosynostosis. Multiple studies demonstrate the safety and low complication rate of resorbable plating systems.However, there is no consensus on which plating system is superior for patient outcomes. This study aims to investigate how the polymer composition of resorbable plating systems utilized in cranial vault reconstruction contributes to wound healing complications. A retrospective chart review was performed at the institution between January 1, 2005 and December 31, 2015. About 202 patients who underwent surgical repair of craniosynostosis were identified. The results showed that patients receiving the Biomet Lactosorb plating system were over twice as likely to have a wound complication within a year of surgery compared to other plating systems used at the institution. Wound complications continued to occur in the Biomet Lactosorb group at ≥180 days after surgery, whereas complications among the other plating systems occurred ≤80 days postoperatively. Half of all patients with wound complications had to undergo reoperation. These data demonstrate the effect of unique polymer compositions on wound healing, and will help to guide future clinical practice and industry development of resorbable plating systems.
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Amano Y, Fujimoto A, Ichikawa N, Sato K, Baba S, Nishimura M, Enoki H, Okanishi T. Cranioplasty with Titanium Might Be Suitable for Adult Epilepsy Surgery After Subdural Placement Surgery To Avoid Surgical Site Infection. World Neurosurg 2019; 131:e503-e507. [PMID: 31382070 DOI: 10.1016/j.wneu.2019.07.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of the present study was to compare the surgical site infection (SSI) rates between resorbable plates and titanium plates used for adult patients with intractable epilepsy who had undergone epilepsy surgery after subdural electrode placement. METHODS We performed subdural electrode surgery, followed by epilepsy surgery, for 87 adult patients with intractable epilepsy. The epilepsy surgery included 75 focus resections and 12 corpus callosotomies. We compared the SSI rates between patients who had undergone cranioplasty with titanium and resorbable plates after epilepsy surgery. RESULTS Of the 87 patients, 43 had undergone cranioplasty with resorbable plates (group A) and 44 had undergone cranioplasty with titanium plates (group B). The frequency of SSI was significantly greater in group A (7 patients; 16.3%) than in group B (1 patient; 2.3%; P = 0.03, Fisher's exact test). Univariate regression analysis also showed a significantly greater infection rate with the resorbable plates (P = 0.024). CONCLUSION For epilepsy surgery of adult patients after subdural electrode placement surgery, the SSI rate for cranioplasty was greater with resorbable plates than with titanium plates.
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Affiliation(s)
- Yuki Amano
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Pascasio DCG, Denadai R, Legaspi GD, Liban SA, Tansipek BU. Treating nasoethmoidal encephalocele in a low-resource country: a surgical experience from a Philippine multidisciplinary craniofacial team. Childs Nerv Syst 2019; 35:1385-1392. [PMID: 31129706 DOI: 10.1007/s00381-019-04149-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/02/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE It was described that nasoethmoidal encephalocele repair in the Philippines has been limited by insufficient resources, financial constraints, and a lack of surgical expertise. The purpose of this study was to report initial results and complications of Philippine patients with nasoethmoidal encephalocele surgically managed with an approach adapted to an environment with limited financial resources. METHODS All patients (n = 21) with nasoethmoidal encephalocele who underwent intracranial and extracranial repairs (frontal wedge osteotomy to access the encephalocele cyst and cranial base defect, dural defect repair, split frontal grafts fixed with polydioxanone sutures to reconstruct the cranial defect and nasal dorsum, and medial canthopexy) from January 2015 to May 2017 were included. The correlations between sizes of masses and cranial defects with the occurrence of complications were tested. The surgical results were classified based on a previously published outcome grading scales I-IV on the need for additional surgery. RESULTS Nineteen patients (90.5%) had unremarkable post-operative course. Two patients (9.5%) presented with complications (cerebrospinal fluid leak and surgical site infection) which were successfully managed with no additional surgery. The sizes of masses and cranial defects were not correlated (p > 0.05) with complications. The overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.5 (between categories II and III). CONCLUSIONS We reported successful surgical repair of nasoethmoidal encephaloceles in Philippine patients by a local multidisciplinary craniofacial team.
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Affiliation(s)
- Dax Carlo G Pascasio
- Division of Plastic and Reconstructive Surgery, Philippine General Hospital, 1730 Taft Avenue, Malate, 1000, Manila, Philippines.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
| | - Gerardo D Legaspi
- Division of Neurosurgery, Philippine General Hospital, Manila, Philippines
| | | | - Bernard U Tansipek
- Division of Plastic and Reconstructive Surgery, Philippine General Hospital, 1730 Taft Avenue, Malate, 1000, Manila, Philippines
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13
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Long-Term Results in Isolated Metopic Synostosis: The Oxford Experience over 22 Years. Plast Reconstr Surg 2019; 143:1313e-1314e. [PMID: 30907793 DOI: 10.1097/prs.0000000000005661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Comparison of Distraction Osteogenesis and Single-Stage Remodeling for Correction of Unilateral Coronal Craniosynostosis. J Craniofac Surg 2019; 30:370-376. [DOI: 10.1097/scs.0000000000005038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Afnan MAM, Saxena AK. Tissue repair in neonatal and paediatric surgery: Analysis of infection in surgical implantation of synthetic resorbable biomaterials. Biomed Mater Eng 2018; 29:799-808. [PMID: 30282335 DOI: 10.3233/bme-181024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There has been increased interest in the use of biomaterials that resorb completely leaving only the patient's native tissue. Synthetic materials are advantageous for tissue repair because they are highly customisable. The infection rate of using resorbable natural materials in paediatric surgery has recently been outlined, but there has not yet been a review of the use of synthetic resorbable materials in paediatric surgery. OBJECTIVES This systematic review analyses the risk of infection after implantation of fully resorbable synthetic biomaterials in paediatric cases. METHODS The literature was searched from January 1970 to January 2018 (inclusive), specifically searching for paediatric cases (0-18 years old), use of synthetic resorbable materials and infection. RESULTS The infection rate in 3573 cases of synthetic resorbable material implantation was 1.1% (41 cases). A Chi-squared test for independence found infection rate to vary among materials. Of the many biomaterials identified in this review, the highest infection rates were seen in Suprathel's use in burns injuries (12.1%). CONCLUSIONS This review found a low infection rate in synthetic resorbable materials used in paediatric surgery, with particularly strong evidence for low infection risk in LactoSorb® use.
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Affiliation(s)
- Michael Anis Mihdi Afnan
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, UK
| | - Amulya Kumar Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, UK
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Korhonen L, Perhomaa M, Kyrö A, Pokka T, Serlo W, Merikanto J, Sinikumpu JJ. Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up. Biomaterials 2018; 185:383-392. [PMID: 30292588 DOI: 10.1016/j.biomaterials.2018.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023]
Abstract
There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN. A randomized, controlled clinical trial included patients, aged 5-15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN®, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes. Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied.
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Affiliation(s)
- Linda Korhonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland.
| | - Marja Perhomaa
- Department of Radiology, Pediatric Radiology, Oulu University Hospital, Finland
| | - Antti Kyrö
- Department of Orthopedics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tytti Pokka
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
| | - Juhani Merikanto
- Department of Orthopedics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
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Evaluation of Fronto-Orbital Advancement Using Titanium-Based Internal Fixation for Corrective Pediatric Craniofacial Surgery. J Craniofac Surg 2018; 29:1542-1545. [PMID: 29916974 DOI: 10.1097/scs.0000000000004689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For successful reshaping of the cranial vault in terms of corrective fronto-orbital advancement (FOA) efficient and reliable internal fixation systems for stabilization of bone fragments are indispensable. The rate of complications and feasibility of corrective FOA with the usage of titanium-based rigid fixation systems is rarely analyzed and discussed. METHODS The authors retrospectively reviewed the medical records of 42 patients who received corrective FOA with the implementation of titanium internal rigid fixation and consecutive secondary surgery for removal. The reliability of the fixation system was judged by the outcome of the FOA as evaluated by the Whitaker score, esthetic outcome as well as by the complication rate of the secondary intervention, necessary for removal of the fixation system. RESULTS All patients were categorized as Whitaker I (no further treatment desirable). Esthetic outcome was excellent in all patients as judged by surgeon and parents. Mean age at the time of FOA was 9.3 months. Time to removal, duration of the second hospital stay for removal of the fixation system, and duration of surgical drains were on average 5 months, 2 days, and 1.7 days, respectively. Mean duration of the secondary surgery was 63 min. No complications occurred. CONCLUSION Our investigation supports the usage of titanium internal rigid fixation systems in pediatric craniofacial surgery, thereby providing a reliable alternative to avoid the well-documented problems of bio-absorbable plate fixation systems.
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Surgical Outcome After Less “Rigid” Fixation in Open Cranial Vault Remodeling for Craniosynostosis. J Craniofac Surg 2018; 29:861-867. [DOI: 10.1097/scs.0000000000004347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
INTRODUCTION Craniosynostosis, the premature fusion of ≥1 cranial sutures, is the leading cause of pediatric skull deformities, affecting 1 of every 2000 to 2500 live births worldwide. Technologies used for the management of craniofacial conditions, specifically in craniosynostosis, have been advancing dramatically. This article highlights the most recent technological advances in craniosynostosis surgery through a systematic review of the literature. METHODS A systematic electronic search was performed using the PubMed database. Search terms used were "craniosynostosis" AND "technology" OR "innovation" OR "novel.' Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts deemed novel by the senior authors were grouped by procedure categories. RESULTS Following review of the PubMed database, 28 of 536 articles were retained. Of the 28 articles, 20 articles consisting of 21 technologies were deemed as being novel by the senior authors. The technologies were categorized as diagnostic imaging (n = 6), surgical planning (n = 4), cranial vault evaluation (n = 4), machine learning (n = 3), ultrasound pinning (n = 3), and near-infrared spectroscopy (n = 1). CONCLUSION Multiple technological advances have impacted the treatment of craniosynostosis. These innovations include improvement in diagnosis and objective measurement of craniosynostosis, preoperative planning, intraoperative procedures, communication between both surgeons and patients, and surgical education.
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Abstract
PURPOSE OF REVIEW To provide an overview of zygomaticomaxillary complex (ZMC) fractures and their treatment. Aspects of anatomy, diagnosis, and treatment objectives of these common fractures will be reviewed including recent literature. RECENT FINDINGS Advances in technology such as guided surgery have allowed for better outcomes and a reduction in surgeon variability with regard to postoperative results. The use of titanium and bioresorbable mini screws and plates have expanded the ability to achieve stable and predictable results. There are many different challenges and techniques that are acceptable to treat zygoma fractures. Surgeon preference and training dictate these methods that vary among specialties. SUMMARY ZMC fractures are commonly encountered in the trauma setting. Although there is a multitude of treatment methods available, the ultimate goal for any surgeon should be to reproduce premorbid form and function. The availability of techniques such as 3D navigation, contralateral mirroring, and advances in fixation technology have shown promise for better outcomes, particularly in severely comminuted or displaced fractures.
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Clinical Evaluation of Standardized Fronto-Orbital Advancement for Correction of Isolated Trigonocephaly. J Craniofac Surg 2018; 29:72-75. [DOI: 10.1097/scs.0000000000004058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement. J Craniofac Surg 2017; 29:170-174. [PMID: 29068973 DOI: 10.1097/scs.0000000000004061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method.Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method.The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm.Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis.
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