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Perioperative Morbidity of Repeat Posterior Cranial Vault Distraction Osteogenesis: A Single-center Experience

Spera, Leigh Jenna MD; Danforth, Rachel MD; Ackerman, Laurie MD; Tholpady, Sunil S. MD, PhD; Gerety, Patrick A. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 46
doi: 10.1097/01.GOX.0000584456.91240.9c
Craniofacial Abstracts

Indiana University, Indianapolis, IN

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

INTRODUCTION: Posterior cranial vault distraction osteogenesis (PVDO) has become the preferred modality in many centers for cranial expansion in syndromic and multisuture craniosynostosis patients. The low morbidity profile and large degree of volumetric expansion have propelled its use. The purpose of this study was to evaluate the perioperative morbidity of repeat PVDO in pediatric patients.

METHODS: A retrospective review of all patients who underwent PVDO was performed from 2015 to 2018. Individual demographics, perioperative data, distraction parameters, and complications were reviewed, and repeat PVDO patients were identified.

RESULTS: A total of 16 patients underwent primary PVDO (16.48 ± 15.44 months old at the time of surgery) in the selected time period. Five of these patients had repeat PVDO performed (30.49 ± 15.32 months old at the time of surgery), with 1 patient requiring a third distraction. Indications for repeat distraction were symptomatic intracranial pressure elevation and halted cranial growth. When comparing primary PVDO to repeat PVDO, operative time (168 ± 55 versus 207 ± 47 minutes; P = 0.14), reported EBL (16.7 ± 9.0 versus 11.3 ± 6.6 ml/kg; P = 0.20), red blood cell transfusion (25.9 ± 15.1 versus 25.2 ± 10.6 ml/kg; P = 0.91), length of intensive care unit stay (3.3 ± 4.3 versus 4.0 ± 4.4 days; P = 0.72), and length of hospital stay (8.4 ± 9.5 versus 5.8 ± 4.0 days; P = 0.53) were not significantly different. Additionally, there was no increased incidence of postoperative complications (37.5% versus 33.3%; P = 0.86).

CONCLUSIONS: Repeat PVDO is comparable in perioperative morbidity to primary PVDO in patients with syndromic or multisuture craniosynostosis. Use of PVDO provides excellent cranial expansion and relief of elevated intracranial pressure while delaying the use of frontal advancement or monobloc procedures.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.