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Modification of the Melbourne Method for Total Calvarial Vault Remodeling

Hughes, Christopher D., MD, MPH*; Isaac, Kathryn V., MD*; Hwang, Paul F., MD*,†; Ganske, Ingrid, MD*; Proctor, Mark R., MD; Meara, John G., MD, DMD, MBA*

Plastic and Reconstructive Surgery – Global Open: July 9, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001848
Latest Articles: PDF Only

Background: Sagittal synostosis is the most common form of single suture synostosis. It often results in characteristic calvarial deformities, including a long, narrow head, frontal bossing, a bullet-shaped occiput, and an anteriorly placed vertex. Several methods for correcting the phenotypic deformities have been described, each with their own advantages and challenges. In this study, we describe a modification of the Melbourne method of total calvarial remodeling for correcting scaphocephaly.

Methods: We conducted a retrospective review of all consecutive patients who underwent total calvarial remodeling using a modified version of the Melbourne technique from 2011 to 2015. We evaluated clinical photographs, computed tomographic imaging, and cephalic indices both pre- and postoperatively to determine morphologic changes after operation.

Results: A total of 9 patients underwent the modified Melbourne technique for calvarial vault remodeling during the study period. Intraoperative blood loss was 260 mL (range, 80–400 mL), and mean intraoperative transfusion was 232 mL (range, 0–360 mL). The average length of stay in the hospital was 3.9 days. The mean cephalic indices increased from 0.66 to 0.74 postoperatively (P < 0.01).

Conclusions: A modified Melbourne method for calvarial vault reconstruction addresses the phenotypic aspects of severe scaphocephaly associated with isolated sagittal synostosis and maintains a homeotopic relationship across the calvaria. It is associated with shorter operative times, lower blood loss, and lower transfusion requirements.

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From the *Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass.

Plastic Surgery Service, USU/Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Md.

Department of Neurosurgery, Boston Children’s Hospital, Boston, Mass.

Published online 9 July 2018.

Received for publication November 16, 2017; accepted May 9, 2018.

Presented at the American Cleft-Palate Craniofacial Association 73rd Annual Meeting, April 2016, Atlanta, Ga.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of the Navy, Department of Defense, nor the U.S. Government.

John G. Meara, MD, DMD, MBA, Department of Plastic and Oral Surgery, Boston Children’s Hospital, 300 Longwood Ave, Hunnewell 1, Boston, MA 02215, E-mail: john.meara@childrens.harvard.edu

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.