20. Spring extraction after Spring Assisted Surgery for sagittal synostosis
Rufolo, Guglielmo1; Maltese, Giovanni2; Kölby, Lars2; Tarnow, Peter2
1University of Naples Federico II, Department of Plastic Surgery, Naples, Italy; 2Sahlgrenska University
Hospital, Department of Plastic Surgery, Goteborg, Sweden
Background: The use of implantable springs in sagittal synostosis was pioneered at the Craniofacial Surgery Unit of Sahlgrenska University Hospital in 1997. The bayonet shaped springs are typically inserted into the calvarial bone through burr holes at the side of the sagittal craniotomy. Six months
after placement, springs are extracted under general anaesthesia though a short incision. The aim of this study was to determine the invasiveness of the spring extraction procedure with regards to safety, complications and bleeding.
Material and methods: Patients were extracted from the Göteborg´s craniofacial registry. All patients operated for sagittal synostosis using the spring technique from 1997 to 2011 were included in the study. Perioperative bleeding, operative time and complication rate were evaluated.
Results: 133 patients fulfilled the criteria and were included in the study. Mean age at the time of springs extraction was 11.7 months. Mean operation time was 33 minutes (SD ±16 min, range 10-105 min, median 30 min). Mean blood loss was 26 ml (SD ±24 ml, range 2-130 ml, median 20 ml). The only complication registered was an intra-operative blood pressure drop after a 110 ml bleeding from the sagittal sinus caused by a dislocated spring. No post-operative complications were registered. Discussions: The use of springs after sagittal craniotomy to correct sagittal sinostosis has become increasingly popular in other craniofacial units since it achieves good results with the advantage of being a less invasive surgical procedure compared to a traditional cranioplasty. A common criticism to spring- assisted surgery is that a second surgical procedure is necessary to remove the springs. Our study demonstrates that springs extraction is a minimal surgical act with low rate of complications.