title: Using bioabsorbable fixation systems in the treatment of pediatric skull deformities leads to good outcomes and low morbidity.
abstract: BACKGROUND
  Bioabsorbable fixation systems have been widely employed in pediatric patients for cranial reconstruction, obviating the complications of hardware migration and imaging artifact occurring with metallic implants. Recent concern over complications unique to bioabsorbable materials, such as inflammatory reaction and incomplete resorption, necessitates additional conclusive studies to further validate their use in pediatric neurosurgery and craniofacial surgery. Likewise, long-term follow-up in this clinical cohort has not previously been described.
  
  
  METHODS
  We included consecutive pediatric patients under the age of 2, from Lucile Packard Children's Hospital, who underwent cranial vault reconstruction with the use of a bioabsorbable fixation system between 2003 and 2010. Hospital records were queried for patient characteristics, intraoperative data, and postoperative complications.
  
  
  RESULTS
  Ninety-five patients with the following preoperative pathologies were analyzed: craniosynostosis (87), cloverleaf skull (5), frontonasal dysplasia (1), and frontonasal encephalocele (2). Median age was 6 months (range 1-24 months). Average case duration was 204 minutes (range 40-392 min), with median of 154 mL blood loss (range 30-500 mL). Ninety-three percent of patients had 1-4 plates implanted with 48% receiving three plates. The median number of screws used was 59 (range 0-130). The median length of hospital stay was 4 days (range 2-127 days) with an average follow-up of 22 months (five postoperative visits). The complications related to hardware implantation included swelling (1%) and broken hardware (1%), the latter of which required reoperation.
  
  
  CONCLUSIONS
  The bioabsorbable fixation systems for cranial vault reconstruction in children less than 2 years of age is safe with tolerable morbidity rates.
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94304, USA.
authors.forename: Melanie G
authors.initials: MG
authors.lastname: Hayden Gephart
authors.forename: Joslyn I
authors.initials: JI
authors.lastname: Woodard
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arrigo
authors.forename: H Peter
authors.initials: HP
authors.lastname: Lorenz
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Schendel
authors.forename: Michael S B
authors.initials: MS
authors.lastname: Edwards
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
mesh_terms: D020341:Absorbable Implants / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012886:Skull / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome