Advertisement

Effectiveness of Immediate Fixation after Cranial Distraction Osteogenesis

Published:November 21, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.011

      Summary

      Background

      Distraction osteogenesis (DO) is the established safe and effective treatment of craniosynostosis (CS) deformities. However, conventional method demonstrates some complications, such as long-term maintenance of the distractor and relapse after distractor removal. There only few studies to overcome these limitations. Therefore, we hypothesized that placing a resorbable plate after removing the distractor will provide additional stability to newly formed bone, shortening the consolidation period and minimizing relapse.

      Methods

      Twenty-six children diagnosed with CS who underwent DO between 2000 and 2019 were retrospectively analyzed. A resorbable plate was fixed across the regenerated bone when distractors were removed. The consolidation period and complication rate were obtained from medical records, and both two- and three-dimensional analyses were performed to obtain relapse rate and brain volume changes using three-dimensional computed tomography.

      Results

      Among 26 patients, the average consolidation period was 90.75±23.75 days in the conventional group (n=11) and 22.77±8.69 days in the intervention group (n=15). In the two-dimensional analysis, the relapse rate was lower in the intervention group. Moreover, in the three-dimensional analysis, the relapse rate of unilateral CS between the affected and unaffected sides was lower in the intervention group. The conventional group had more complications (skin defect and distractor exposure).

      Conclusion

      Resorbable plate placement after distractor removal helps shorten the consolidation period and prevent relapse in pediatric patients with cranial DO. It reduces complications and shows stable results in terms of cranial morphology and symmetric brain growth in patients with CS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Serlo WS
        • Ylikontiola LP
        • Lähdesluoma N
        • et al.
        Posterior cranial vault distraction osteogenesis in craniosynostosis: Estimated increases in intracranial volume.
        Childs Nerv Syst. 2011; 27: 627-633
        • Ilizarov GA
        • Ledyaev VI.
        The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969.
        Clin Orthop Relat Res. 1992; 280: 7-10
        • McCarthy JG
        • Schreiber J
        • Karp N
        • Thorne CH
        • Grayson BH.
        Lengthening the human mandible by gradual distraction.
        Plast Reconstr Surg. 1992; 89 (discussion 9): 1-8
        • Sugawara Y
        • Hirabayashi S
        • Sakurai A
        • Harii K.
        Gradual cranial vault expansion for the treatment of craniofacial synostosis: A preliminary report.
        Ann Plast Surg. 1998; 40: 554-565
        • Schindeler A
        • McDonald MM
        • Bokko P
        • Little DG.
        Bone remodeling during fracture repair: The cellular picture.
        Semin Cell Dev Biol. 2008; 19: 459-466
        • Karp NS
        • McCarthy JG
        • Schreiber JS
        • Sissons HA
        • Thorne CH.
        Membranous bone lengthening: A serial histological study.
        Ann Plast Surg. 1992; 29: 2-7
        • Yasui N
        • Sato M
        • Ochi T
        • et al.
        Three modes of ossification during distraction osteogenesis in the rat.
        J Bone Joint Surg Br. 1997; 79: 824-830
        • Mundinger GS
        • Rehim SA
        • Johnson 3rd, O
        • et al.
        Distraction osteogenesis for surgical treatment of craniosynostosis: A systematic review.
        Plast Reconstr Surg. 2016; 138: 657-669
        • Al-Namnam NMN
        • Hariri F
        • Rahman ZAA.
        Distraction osteogenesis in the surgical management of syndromic craniosynostosis: A comprehensive review of published papers.
        Br J Oral Maxillofac Surg. 2018; 56: 353-366
        • Hill CA
        • Vaddi S
        • Moffitt A
        • et al.
        Intracranial volume and whole brain volume in infants with unicoronal craniosynostosis.
        Cleft Palate Craniofac J. 2011; 48: 394-398
        • Fedorov A
        • Beichel R
        • Kalpathy-Cramer J
        • et al.
        3D slicer as an image computing platform for the quantitative imaging network.
        Magn Reson Imaging. 2012; 30: 1323-1341
        • Fearon JA.
        Evidence-based medicine: Craniosynostosis.
        Plast Reconstr Surg. 2014; 133: 1261-1275
        • Imai K
        • Komune H
        • Toda C
        • et al.
        Cranial remodeling to treat craniosynostosis by gradual distraction using a new device.
        J Neurosurg. 2002; 96: 654-659
        • Kim SW
        • Shim KW
        • Plesnila N
        • Kim YO
        • Choi JU
        • Kim DS.
        Distraction vs remodeling surgery for craniosynostosis.
        Childs Nerv Syst. 2007; 23: 201-206
        • Sugawara Y
        • Uda H
        • Sarukawa S
        • Sunaga A.
        Multidirectional cranial distraction osteogenesis for the treatment of craniosynostosis.
        Plast Reconstr Surg. 2010; 126: 1691-1698
        • Patel N
        • Fearon JA.
        Treatment of the syndromic midface: A long-term assessment at skeletal maturity.
        Plast Reconstr Surg. 2015; 135: 731e-742e
        • Akizuki T
        • Komuro Y
        • Ohmori K.
        Distraction osteogenesis for craniosynostosis.
        Neurosurg Focus. 2000; 9: e1
        • Witherow H
        • Thiessen F
        • Evans R
        • Jones BM
        • Hayward R
        • Dunaway D.
        Relapse following frontofacial advancement using the rigid external distractor.
        J Craniofac Surg. 2008; 19: 113-120
        • Witherow H
        • Dunaway D
        • Evans R
        • et al.
        Functional outcomes in monobloc advancement by distraction using the rigid external distractor device.
        Plast Reconstr Surg. 2008; 121: 1311-1322
        • Richland BK
        • Ellstrom C
        • Ahmad A
        • Jaffurs D.
        Resorbable plates prevent regression in pediatric mandibular distraction osteogenesis.
        Ann Plast Surg. 2017; 78: S204-S207
        • Deschamps-Braly J
        • Hettinger P
        • el Amm C
        • Denny AD.
        Volumetric analysis of cranial vault distraction for cephalocranial disproportion.
        Pediatr Neurosurg. 2011; 47: 396-405
        • Judy BF
        • Swanson JW
        • Yang W
        • et al.
        Intraoperative intracranial pressure monitoring in the pediatric craniosynostosis population.
        J Neurosurg Pediatr. 2018; 22: 475-480
        • Tamburrini G
        • Caldarelli M
        • Massimi L
        • Santini P
        • Di Rocco C.
        Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review.
        Childs Nerv Syst. 2005; 21: 913-921
        • Thompson DN
        • Malcolm GP
        • Jones BM
        • Harkness WJ
        • Hayward RD.
        Intracranial pressure in single-suture craniosynostosis.
        Pediatr Neurosurg. 1995; 22: 235-240