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Long-Term Outcomes of Pediatric Cranial Reconstruction Using Resorbable Plating Systems for the Treatment of
Leslie G Branch1, Clayton Crantford, Teresa Cunningham
1Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC.
Insights
Resorbable plates, particularly Lactosorb, offer a safe and cost-effective solution for pediatric craniosynostosis reconstruction. Long-term outcomes show low complication rates and minimal need for hardware removal.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Biomaterials Science
Background:
- Resorbable plating in cranial reconstruction for craniosynostosis presents fewer complications than rigid hardware.
- Limited long-term outcome data exists for pediatric patients undergoing cranial vault reconstruction with resorbable technology.
Purpose of the Study:
- To evaluate the long-term outcomes and complication rates of resorbable plating systems in pediatric patients undergoing cranial vault reconstruction for craniosynostosis.
Main Methods:
- Retrospective review of 203 pediatric patients undergoing cranial vault reconstruction for craniosynostosis over 15 years.
- Use of MacroPore or Lactosorb resorbable plates for fixation.
- Mean follow-up of 6.4 years.
Main Results:
- Overall unplanned reoperations occurred in 5.4% of patients.
- Hardware exposure requiring removal was rare (1.5%), exclusively with MacroPore plates.
- Lactosorb plating demonstrated a safe, reproducible, and cost-effective modality with low complication rates.
Conclusions:
- Resorbable plating systems, especially Lactosorb, are safe and effective for pediatric cranial reconstruction.
- These systems provide rigid fixation without growth restriction and have a low likelihood of removal.
- Lactosorb offers a reproducible and inexpensive option for craniosynostosis repair.
Background:
Resorbable plating in cranial reconstruction for craniosynostosis has fewer reported complications than rigid hardware. Few long-term outcome studies exist for pediatric patients treated with this technology for cranial vault reconstruction.
Methods:
A retrospective review was performed on pediatric patients undergoing cranial vault reconstruction for craniosynostosis by 3 surgeons over a 15-year period. MacroPore (Cytori Therapeutics, San Diego, CA) or Lactosorb (Walter Lorenz Surgical Inc, Jacksonville, FL), composed of polyglycolic and polylactic acids, was used for resorbable plate fixation.
Results:
A total of 203 patients underwent resorbable plate fixation with a mean age of 15.8 months at surgery. Mean length of follow-up was 6.4 years. Lactosorb plating system was used in the majority of patients (74%) compared with MacroPore plating system (26%). Overall, unplanned reoperations were required in 5.4% of patients. Palpable hardware was noticed in 10.3% of patients. Only 3 patients (1.5%) developed exposure of the resorbable hardware requiring removal, all MacroPore plates. Four patients (2%) developed surgical site infection and 3 patients (1.5%) developed a seroma. There were 15.8% requiring later surgical revision with cranial vault expansion or cranioplasty with grafts for residual cranial defects. The majority of revisional reoperations (81%) occurred in the first half of the study before the addition of Allogenix.
Conclusions:
Resorbable plating systems, specifically Lactosorb, for cranial reconstruction are a safe, reproducible, inexpensive modality with very low complication rates. They have 3-dimensional stability, rigid fixation without causing growth restriction, and lower likelihood of need for removal.
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