title: Relaxed pericranial flap for distraction osteogenesis to treat craniosynostosis: a technique for wound reinforcement--technical note.
abstract: OBJECTIVE
  Although distraction osteogenesis has been widely accepted to treat craniosynostosis, it occasionally results in wound complications. Positing that they are attributable to the tense pericranium under the scalp, we developed a simple technique to relax the pericranial flap.
  
  
  METHODS
  In 12- to 15-month-old infants (mean 13 months), we placed a coronal skin incision and dissected the scalp at the subgaleal layer. Then, we peeled the intact pericranium away from the skull along the planned osteotomy to obtain flaps with pedicles on the caudal part. After osteotomy and setting of the distraction device, the pericranial flaps freed from the scalp flap were repositioned to fit the osteotomy line, dura, and distraction device. The galea and skin were approximated layer by layer.
  
  
  RESULTS
  The shape of the skull was successfully corrected, and the bone defect created by expansion was filled by osteogenesis in all patients. During a mean follow-up period of 42.2 months, we encountered no wound complications.
  
  
  CONCLUSIONS
  The replaced relaxed pericranium closely adhered to the osteotomy, and the distraction device facilitated vascular growth and bone restoration. Bone resorption was prevented and skin expansion promoted. In patients with iatrogenic dural injury, the pericranium over the injured dura serves as a barrier to prevent cerebrospinal fluid leakage.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan, nakahara19@hotmail.com.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Nakahara
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Ikemoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Masaru
authors.initials: M
authors.lastname: Yamada
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D007223:Infant; D019857:Osteogenesis, Distraction / Q000379:methods*; D013524:Surgical Flaps