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Using bioabsorbable fixation systems in the treatment of pediatric skull deformities leads to good outcomes and low morbidity

Hayden Gephart, Melanie ; Woodard, Joslyn ; Arrigo, Robert ; Lorenz, H. ; Schendel, Stephen ; Edwards, Michael ; Guzman, Raphael

In: Child's Nervous System, 2013, vol. 29, no. 2, p. 297-301

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    Titre
    • Using bioabsorbable fixation systems in the treatment of pediatric skull deformities leads to good outcomes and low morbidity
    Auteur
    • Hayden Gephart, Melanie. Department of Neurosurgery, Stanford University Medical Center, 94304, Stanford, CA, USA
    • Woodard, Joslyn. Stanford University School of Medicine, 94305, Stanford, CA, USA
    • Arrigo, Robert. Stanford University School of Medicine, 94305, Stanford, CA, USA
    • Lorenz, H.. Division of Pediatric Plastic Surgery, Stanford University Medical Center, 94304, Stanford, CA, USA
    • Schendel, Stephen. Division of Pediatric Plastic Surgery, Stanford University Medical Center, 94304, Stanford, CA, USA
    • Edwards, Michael. Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, 94304, Stanford, CA, USA
    • Guzman, Raphael. Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, 94304, Stanford, CA, USA
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:320146
    Summary
    Background: Bioabsorbable fixation systems have been widely employed in pediatric patients for cranial reconstruction, obviating the complications of hardware migration and imaging artifact occurring with metallic implants. Recent concern over complications unique to bioabsorbable materials, such as inflammatory reaction and incomplete resorption, necessitates additional conclusive studies to further validate their use in pediatric neurosurgery and craniofacial surgery. Likewise, long-term follow-up in this clinical cohort has not previously been described. Methods: We included consecutive pediatric patients under the age of 2, from Lucile Packard Children's Hospital, who underwent cranial vault reconstruction with the use of a bioabsorbable fixation system between 2003 and 2010. Hospital records were queried for patient characteristics, intraoperative data, and postoperative complications. Results: Ninety-five patients with the following preoperative pathologies were analyzed: craniosynostosis (87), cloverleaf skull (5), frontonasal dysplasia (1), and frontonasal encephalocele (2). Median age was 6months (range 1-24months). Average case duration was 204minutes (range 40-392min), with median of 154mL blood loss (range 30-500mL). Ninety-three percent of patients had 1-4 plates implanted with 48% receiving three plates. The median number of screws used was 59 (range 0-130). The median length of hospital stay was 4days (range 2-127days) with an average follow-up of 22months (five postoperative visits). The complications related to hardware implantation included swelling (1%) and broken hardware (1%), the latter of which required reoperation. Discussion: The bioabsorbable fixation systems for cranial vault reconstruction in children less than 2years of age is safe with tolerable morbidity rates