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Perioperative outcomes of secondary frontal orbital advancement (FOA) after posterior vault distraction osteogenesis (PVDO): a retrospective comparative cohort study
Rosaline Zhang, Lawrence Lin, Hoppe Ian, Swanson Jordan, Scott Bartlett, Kate Magoon, Jesse Taylor.
Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.

BACKGROUND: Posterior cranial vault distraction osteogenesis (PVDO), shown to provide greater intracranial expansion than conventional remodeling techniques, has gained popularity as the initial intervention in patients with syndromic craniosynostosis. Patients may require secondary frontal orbital advancement (FOA) following PVDO, but little is known about the perioperative risks associated with this staged management. The purpose of this study is to compare the perioperative morbidity profile of secondary FOA (study) to that of primary FOA (control).
METHODS: A retrospective review was conducted for patients with syndromic or complex craniosynostosis undergoing FOA between 2004 and 2017. Univariate and multivariate analysis of demographic and perioperative data were performed.
RESULTS: 43 subjects met inclusion criteria, 17 in the study cohort and 26 in the control cohort. The two cohorts were similar with regards to diagnosis and suture involvement, as well as weight-adjusted estimated blood loss, blood transfusion volume and length of hospital stay (p>0.050). Secondary FOA procedures required longer operating time (23158 vs 26462 min, p=0.031) and anesthesia time (34160 vs 40356min, p=0.002). The secondary FOA cohort had a significantly greater proportion of procedures with difficult wound closure (19% vs 59%, p=0.008). Two subjects in the study cohort developed a wound dehiscence, compared to one subject in the control cohort (p=0.552). FOA as a secondary procedure after PVDO was a predictor variable in multivariate analysis for wound difficulties (Odds Ratio 8.6, p = 0.038).
CONCLUSIONS: Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Calibri",sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} PVDO has been an important advancement in the surgical management of syndromic craniosynostosis patients, delaying and in some cases obviating the need for anterior cranial expansion. For patients who do require FOA after PVDO, surgical wound closure appears to be more difficult, potentially increasing operative time. However, there is no increased blood loss or length of hospital stay. Syndromic and complex craniosynostosis may safely be managed with initial PVDO followed by FOA, with minimal increased perioperative risk.


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