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Long-term Outcomes of Primary Craniofacial Reconstruction for Craniosynostosis: A 12-year Experience.
MedLine Citation:
PMID:  21311385     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: The purpose of this study was to critically assess long-term outcomes after open reconstruction of craniosynostosis within the recent decade. METHODS:: The authors performed a retrospective, IRB-approved review of open repair for craniosynostosis between 1997-2009. Surgical factors, complications, and long-term outcomes were assessed. Pearson chi-square, Fisher exact, and Kaplan-Meier analyses were performed. RESULTS:: Of 212 patients, 72 underwent primary extended synostectomy and 140 had traditional open craniofacial repair. Mean follow-up was 36.3 months (0.5 - 138 months). Indications included sagittal (N=96), metopic (N=40), unicoronal (N=33), bicoronal (N=24), multisutural (N=15), bilambdoidal (N=3), and unilambdoidal (N=1) synostoses. 8.5% of patients were syndromic. Surgical reconstruction was performed at a mean age of 11.3 months (0.2 - 117.8 months), including nonsyndromic patients at an average age of 10.6 months and syndromic patients at an age of 19.3 months. There were no mortalities. A 3.3% complication rate included 2 cerebral contusions, 2 hematomas, 1 CSF leak, 1 infection, and 1 wound breakdown. Patients were categorized as 89.2% Whitaker class I/II and 10.8% Whitaker class III/IV. Major and total reoperation rates were 9.0% and 10.8%, respectively. Higher total reoperation rate and Whitaker class III/IV distribution significantly correlated with syndromic diagnosis, bicoronal synostosis, and surgical age < 6 months. CONCLUSIONS:: In this experience of contemporary open craniosynostosis surgery, rates of morbidity, mortality, and reoperation were low. These results support the merits of surgical delay, targeting an age ≥ 6 months, and may serve as a more accurate metric of comparison to current minimally invasive techniques for craniosynostosis repair.
Authors:
Mitchel Seruya; Albert K Oh; Michael J Boyajian; Jeffrey C Posnick; John S Myseros; Amanda L Yaun; Robert F Keating
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-8
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  -     ISSN:  1529-4242     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Washington, D.C., From the Department of Plastic Surgery at Georgetown University Hospital and the Departments of Plastic Surgery and Neurosurgery at Children's National Medical Center.
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