title: Prevention of halo pin complications in post-cranioplasty patients.
abstract: BACKGROUND
  Distraction Osteogenesis has been successfully implemented in the treatment of maxillary hypoplasia. By using the Rigid External Distraction device (RED) the maxilla can be advanced without the need for bone grafts, providing more stability to the repositioned maxilla.
  
  
  BACKGROUND
  The introduction of the RED system in craniofacial surgery has given rise to previously unseen problems.
  
  
  OBJECTIVE
  To provide a set of protocol improvements that might prevent the intracranial pin migration seen at the removal of a RED-II in one patient.
  
  
  CONCLUSIONS
  Although the RED device has been shown to achieve good clinical results, there are some disadvantages to the system. There is a high incidence of pin tract infections - leading to loosening of the pins and loss of rigidity. Also, the external ring is prone to traumatic injury. Furthermore, the positioning of the pins can be difficult in thin bone. The improvements used in our protocol might prevent this complication.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus University Medical Centre, The Netherlands. j.j.n.m.vandermeulen@erasmus.nl
authors.forename: Jacques
authors.initials: J
authors.lastname: van der Meulen
authors.forename: Eppo
authors.initials: E
authors.lastname: Wolvius
authors.forename: Karel
authors.initials: K
authors.lastname: van der Wal
authors.forename: Birte
authors.initials: B
authors.lastname: Prahl
authors.forename: Michiel
authors.initials: M
authors.lastname: Vaandrager
mesh_terms: D000293:Adolescent; D001858:Bone Nails / Q000009:adverse effects*; D004867:Equipment Design; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007710:Klebsiella Infections / Q000209:etiology*; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D016920:Meningitis, Bacterial / Q000382:microbiology; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000295:instrumentation*