RESUMEN
Fronto-orbital advancement and remodeling for craniosynostosis is extensive surgery and is associated with potential risks; the most significant of these is blood loss. We prospectively studied 116 consecutive patients undergoing fronto-orbital advancement by the same surgical team for a 5-year 6-month period to determine what factors are associated with blood loss and transfusion of blood products. The data collected on the calvarial sutures involved were whether the patient had a diagnosed syndrome, the age at operation, the length of the operation, the estimated blood volume lost during the perioperative course, the number of units of packed cells transfused (donor exposures), and the use of other blood products. The mean (SD) total blood volume lost was 116% (5.4) of the estimated preoperative volume. The median number of whole units of packed cells transfused was 2 units. Other blood products were given in 28% of the cases. There was significantly greater blood loss in those patients with recognized craniofacial syndromes, pansynostosis, an operating time longer than 5 hours, and an age of 18 months or younger at operation. The use of other blood products was associated with those patients losing a blood volume higher than the mean.
Asunto(s)
Pérdida de Sangre Quirúrgica , Anomalías Craneofaciales/cirugía , Hueso Frontal/cirugía , Órbita/cirugía , Procedimientos de Cirugía Plástica/métodos , Factores de Edad , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Sustitutos Sanguíneos/uso terapéutico , Transfusión Sanguínea/estadística & datos numéricos , Transfusión de Sangre Autóloga/estadística & datos numéricos , Volumen Sanguíneo , Niño , Preescolar , Craneosinostosis/clasificación , Craneosinostosis/cirugía , Soluciones Cristaloides , Transfusión de Eritrocitos/estadística & datos numéricos , Volumen de Eritrocitos , Factor VIII/uso terapéutico , Fibrinógeno/uso terapéutico , Fibronectinas/uso terapéutico , Predicción , Hematócrito , Hemoglobinas/análisis , Humanos , Lactante , Soluciones Isotónicas/uso terapéutico , Tiempo de Tromboplastina Parcial , Plasma , Transfusión de Plaquetas/estadística & datos numéricos , Estudios Prospectivos , Tiempo de Protrombina , Factores de TiempoRESUMEN
The birth prevalence of craniosynostosis (premature suture fusion) is 300-500 per 1,000,000 live births. Surgical management involves the release of the synostosed suture. In many cases, however, the suturectomy site rapidly reossifies, further restricts the growing brain and alters craniofacial growth. This resynostosis requires additional surgery, which increases patient morbidity and mortality. New findings in bone biology and molecular pathways involved with suture fusion, combined with novel tissue engineering techniques, may allow the design of targeted and complementary therapies to decrease complications inherent in high-risk surgical procedures. This paper selectively reviews recent advances in i) identifying genetic mutations and the aetiopathogenesis of a number of craniosynostotic conditions; ii) cranial suture biology and molecular biochemical pathways involved in suture fusion; and iii) the design, development and application of various vehicles and tissue engineered constructs to deliver cytokines and genes to cranial sutures. Such biologically based therapies may be used as surgical adjuncts to rescue fusing sutures or help manage postoperative resynostosis.