title: Correction of craniosynostosis using modified spring-assisted surgery.
abstract: BACKGROUND
  The use of springs in craniofacial surgery was originated at Sahlgrenska University Hospital in 1997 as a way of remodeling the cranial vault postoperatively. After a decade of development, spring technology has been improved to a greater extent. However, there still exist some problems, such as the poor consistency of steel wire stretches, the wrong position of steel wire, the problem of increasing the elasticity of springs, and so on.
  
  
  METHODS
  We have designed a spring device for external uses. This device is composed of 3 parts. The first part is the outside of the spring ring. This ring is the same as the internal spring, only a little bigger. The second part is a small U-shaped hook, which is made of titanium plates and linked to the skull portion. The U-shaped hook is approximately 1 cm long and 1 cm wide. The hang is approximately 1 cm long and 0.6 cm wide. The U-shaped level length is 1 cm, but the level width should be equal to or bigger than the thickness of the skull. The third part is a steel wire, which is placed at 1 end of hook. We first conduct a strip craniotomy, then put 2 hooks at the bone ends and, after that, fix hooks on the skull. Finally, we pull the steel wire of the hook end out of the scalp, connect it with the external spring, and draw out the external spring. We performed 24 craniofacial spring placement procedures for 12 patients with craniosynostosis.
  
  
  RESULTS
  We used 6 springs for 3 patients who had anterior plagiocephaly, 12 springs for 6 patients who had scaphocephaly, and 3 springs for another patient who had metopic synostosis and holoprosencephaly. We also used 3 springs for 2 patients who had metopic synostosis. The 12 patients have not required further surgeries so far, and there were no major complications. Spring dislodgement had not caused any complication in early cases. We could easily change the position of the spring rings from outside the scalp, regularly correct the elasticity of the spring rings, and replace spring rings to increase the traction. The head shapes of the 12 children have been improved significantly to use external spring rings.
  
  
  CONCLUSIONS
  This therapeutic modality in craniofacial surgery has allowed minimization of the extent of surgery without compromising clinical outcomes. The authors have shown that the use of external spring techniques is safe and, in selected situations, offer significant advantages over other methods of treatment. It makes up for a number of shortcomings of internal springs.
authors.affiliation: From the *Department of Plastic Surgery, Nanjing Children's Hospital, affiliated with Nanjing Medical University, Nanjing, China; and †Department of Plastic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Shen
authors.forename: Jie
authors.initials: J
authors.lastname: Cui
authors.forename: Jianbin
authors.initials: J
authors.lastname: Chen
authors.forename: Jijun
authors.initials: J
authors.lastname: Zou
authors.forename: Yi
authors.initials: Y
authors.lastname: Ji
authors.forename: Haini
authors.initials: H
authors.lastname: Chen
authors.forename: Mu
authors.initials: M
authors.lastname: Xiongzheng
mesh_terms: D001864:Bone Wires; D003398:Craniosynostoses / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D004548:Elasticity; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods*; D011182:Postoperative Care; D012886:Skull / Q000601:surgery; D013193:Stainless Steel; D013525:Surgical Instruments
chemical_list: D013193:Stainless Steel