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Distraction Osteogenesis for Unicoronal Craniosynostosis: Rotational Flap Technique and Case Series

Brandel, Michael G. B.A.; Dalle Ore, Cecilia L. B.A.; Reid, Chris M. M.D.; Zhu, William B.A.; Lance, Samuel M.D.; Meltzer, Hal M.D.; Gosman, Amanda A. M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 904e-908e
doi: 10.1097/PRS.0000000000005053
Pediatric/Craniofacial: Ideas and Innovations
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Background: The limitations of the soft-tissue envelope, devascularized bone grafts, and relapse of the deformity are important considerations in the surgical treatment of unicoronal craniosynostosis. The authors report their technique evolution of distraction osteogenesis for treatment of patients with unicoronal craniosynostosis.

Methods: Open anterior cranial vault reconstruction combined with internal distraction was used, with the aid of virtual surgical planning. Technique evolution included maximizing bone flap perfusion by means of limited rotational flap osteotomies, and preservation of dural attachments. Clinical and procedural characteristics including distraction protocol, intracranial volume change, efficiency of distraction, transfusion, operative time, length of hospitalization, complications, and postoperative outcomes were analyzed.

Results: Sixteen patients with nonsyndromic unicoronal craniosynostosis underwent repair between August of 2013 and December of 2016. Mean age was 9.0 months. Distractors were advanced a mean of 27.1 mm and achieved a cranial volume change of 29.5 percent, with a mean efficiency of 1.3 percent increase per millimeter of distraction. Mean operating time was 169.3 minutes. Complications were predominately related to infections at the distractor site. At most recent follow-up, all patients had a Whitaker grade I result.

Conclusions: Distraction osteogenesis can be a safe and effective method of achieving satisfactory aesthetic outcomes and volume expansion for patients with unicoronal craniosynostosis. The technique presented is proposed to maximize bone flap viability and limit relapse of deformity. Further long-term follow-up is needed for definitive comparison with traditional anterior cranial vault reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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La Jolla and San Diego, Calif.

From the School of Medicine, the Division of Plastic Surgery, Department of Surgery, and the Department of Neurosurgery, University of California, San Diego; and the Fresh Start Center for Craniofacial Anomalies, Rady Children’s Hospital San Diego.

Received for publication November 21, 2017; accepted June 28, 2018.

Presented at the Joint American Society of Craniofacial Surgery and American Society of Pediatric Neurosurgeons Symposium, in Maui, Hawaii, January 24 through 25, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Amanda A. Gosman, M.D., Department of Plastic Surgery, Rady Children’s Hospital San Diego, 200 West Arbor Drive, San Diego, Calif. 92103-8890, agosman@ucsd.edu

Copyright © 2018 by the American Society of Plastic Surgeons