American Association of Plastic Surgeons

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Secondary Suture Fusion After Primary Correction of Craniosynostosis: Recognition of the Problem and Identification of Risk Factors
Elbert E. Vaca, MD1, Neil Sheth, BA2, Arun K. Gosain, MD1.
1Division of Plastic & Reconstructive Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

PURPOSE
Secondary cranial suture fusion after synostotic suture release is rarely reported in the literature. Furthermore, it is unclear if there are variables predictive of this complication. The purpose of this study is to report the incidence and analyze if there are variables associated with secondary cranial suture fusion after primary correction of craniosynostosis.
METHODS
A single institution retrospective case-control study was conducted of all patients who underwent operative treatment for craniosynostosis from April 2008 May 2017. Patients with less than 1 year of follow-up, including a 1 year post-operative CT scan, were excluded. Preoperative, intraoperative, and postoperative variables were analyzed using univariate and multivariate analyses.
RESULTS
Seventy-four patients were identified. Primary surgical interventions included cranial vault remodeling (87.5%), minimally invasive suturectomy (7.8%), cranial distraction (4.7%), and spring cranioplasty (4.7%). Ten patients (13.5%) had secondary suture fusion, with suture fusion occurring at a site other than the initial pathologic suture in 80% of patients. Sixty percent of secondary fusions presented as pansynostosis, compared with 20% pre-operatively. On univariate analysis, bicoronal synostosis (OR 5.43) and cranial distraction (OR 8.71) were significantly associated with secondary suture fusion (p < 0.05). On multivariate analysis, bicoronal synostosis approached significance (p = 0.06), while intraoperative dural tear was associated with re-synostosis (p = 0.04).
CONCLUSIONS
Secondary cranial suture fusion is rarely reported and occurs more commonly than previously recognized. Furthermore, secondary fusion often occurs in sutures other than the initially involved pathologic suture, and risk factors may include bicoronal synostosis and intraoperative dural tears.


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