Treatment of unicoronal craniosynostosis with distraction osteogenesis techniques preserves blood supply to the frontal bone flap
Alvin Wong MD1-2, Samuel H Lance MD1-2, Amanda A Gosman MD1-2 1Rady Children's Hospital, San Diego, California 2University of California San Diego, San Diego, California
Background: Unicoronal craniosynostosis (UCS) remains a challenging problem. Long-term results are often unsatisfactory secondary to recurrence of the original deformity, requiring secondary operations such as fat grafting or even complete redo calvarial remodeling. Distraction osteogenesis (DO) has recently emerged as a new method for treatment of UCS, and has demonstrated good results in the short term, five to six years from initial operation, with little need for reoperation. One of the theoretical benefits of DO include preservation of blood supply to the frontal bone following osteotomy, as the frontal bone is not completely removed and reshaped as is done during a traditional fronto-orbital advancement (FOA); preservation of blood supply may allow for more robust bony healing and preservation of long-term growth potential, but this has not been previously demonstrated. In this case report, we demonstrate unequivocally that blood supply to the frontal bone is preserved following osteotomy for creation of a rotational bone flap.
Methods: Frontal bone flap creation via osteotomy for DO treatment of UCS was performed. Indocyanine green was injected intravenously, and bone perfusion was assessed with a fluorescence imaging system.
Results: Following frontal bone flap creation via osteotomy, perfusion to the osteotomized portion of the frontal bone flap is preserved (Fig 1A). Blood flow is seen crossing the midline of the frontal bone from the non-osteotomized to the osteotomized side. Following removal of the distractor, perfusion in the osteoid consolidate is also demonstrated (Figs 2B and C).
Conclusion: Preservation of blood supply has not been previously demonstrated empirically in the setting of DO treatment of UCS. We show for the first time that during frontal bone flap creation, blood flow to the osteotomized portion of the frontal bone flap is maintained. Robust blood flow to the osteoid consolidate is also demonstrated. This data supports the use of DO in treatment of UCS over that of FOA, as preserved blood supply to the bone is more likely to support improved healing and long-term results.
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