| 1. |
- Kljajić, Marizela, et al.
(författare)
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Children Treated for Nonsyndromic Craniosynostosis Exhibit Average Adaptive Behavior Skills with Only Minor Shortcomings
- 2021
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Ingår i: Plastic and reconstructive surgery. - 1529-4242. ; 147:2, s. 453-464
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Tidskriftsartikel (refereegranskat)abstract
- Copyright © 2021 by the American Society of Plastic Surgeons. BACKGROUND: Adaptive behavior skills are important when assessing cognitive functions related to daily life; however, few studies have assessed these skills in patients treated for nonsyndromic craniosynostosis. In this study, the authors assessed the adaptive behavior skills of children treated for craniosynostosis and examined whether their outcomes are related to surgical technique. METHODS: The Adaptive Behavior Assessment System, 2nd Edition, parent report was used for children (age, 7 to 16 years) treated for sagittal (n = 41), metopic (n = 24), and other rare synostoses (n = 8). Background data, including intelligence quotient, were controlled for confounders. RESULTS: All evaluated children treated for craniosynostosis were estimated as lower in all aspects of adaptive behavior skills (full-scale, conceptual, social, and practical composites; effect size, 0.36 to 0.44) as compared with norms. The sagittal group showed shortcomings in social composite (effect size, 0.48) and subscales measuring self-care and self-direction, although no difference was observed between spring-assisted surgery and pi-plasty regarding outcomes of adaptive behavior skills. In addition, children treated for metopic synostosis showed results indicating shortcomings with adaptive behavior according to the full-scale, conceptual, and social composites (effect size, 0.53 to 0.61) relative to norms. Furthermore, attrition analysis revealed no significant differences between responders (rate, 80.2 percent) and nonresponders. CONCLUSION: These results found that children treated for craniosynostosis display average adaptive behavior skills, and that the two surgical techniques used to treat sagittal synostosis did not differ in their behavioral outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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| 2. |
- Hallen, T., et al.
(författare)
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Cranioplasty without Periosteal Dissection Reduces Blood Loss in Pi-Plasty Surgery for Sagittal Synostosis
- 2017
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Ingår i: Pediatric Neurosurgery. - : S. Karger AG. - 1016-2291 .- 1423-0305. ; 52:4, s. 284-287
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Cranioplasty is often accompanied by a substantial oozing bleeding from the bone surface and bone edges. Our aim was to measure if strict subgaleal dissection without any periosteal release reduces blood loss during pi-plasty surgery for sagittal synostosis. Method: A group of 32 children who underwent pi-plasty surgery at the Sahlgrenska University Hospital between 2010 and 2014 for premature sagittal synostosis with traditional subgaleal dissection combined with incision and release of the periosteum adjacent to the osteotomy lines was compared to a group of 7 children who underwent pi-plasty with strict subgaleal dissection and osteotomy through the bone with the periosteum attached. Information about blood loss and body weight was extracted from medical records. Results: The blood loss in the group of 7 children with strict subgaleal dissection was 102 +/- 86 mL (mean +/- SD) (10 +/- 7 mL/kg) compared to 320 +/- 119 mL (32 +/- 12 mL/kg) in the control group with traditional periosteal release (p < 0.001). Conclusion: Intact periosteum at the osteotomy lines significantly reduces blood loss in pi-plasty surgery for sagittal synostosis. The mechanism is likely because of preserved veins between the bone surface and periosteum.
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| 3. |
- Kölby, David, 1993, et al.
(författare)
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Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure
- 2017
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Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 28:3, s. 666-669
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. Materials and Methods: This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. Results: In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 +/- 65.3mL (mean +/- standard deviation). The operative time was 67.9 +/- 21.5 minutes and the hospital stay was 4.8 +/- 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 +/- 174.4 mL. The operative time was 126.0 +/- 31.7 minutes and the hospital stay was 7.1 +/- 1.4 days. Conclusion: Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.
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| 4. |
- Silva, Ingrid, et al.
(författare)
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Quality of life in patients undergoing orthognathic surgery - A two-centered Swedish study
- 2016
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Ingår i: Journal of Cranio-Maxillofacial Surgery. - : Elsevier BV. - 1010-5182 .- 1878-4119. ; 44:8, s. 973-978
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Surgical corrections of dentofacial deformities have both physical and psychological impact on quality of life (QoL). The objectives of the present study were to evaluate the impact of oral health related problems on QoL before and after a combination of orthodontic treatment and orthognathic surgery. Additionally, the study aimed to identify correlations between different dentofacial patterns and possible improvements due to treatment. Material and methods: In a prospective study, we evaluated fifty patients before start of treatment, 6 weeks and 6 months postoperatively. The questionnaires used were: OHIP-14 (Short Form Oral Health Impact Profile), a condition-specific QOL approach (Orthognathic Quality of Life Questionnaires; OQLQ) and a social-demographic questionnaire. Results: There was a statistically significant improvement in the OHIP domains from baseline to 6 months follow-up and for the OQLQ the improvement was significant both at 6 weeks and 6 months in relation to the baseline data. Conclusion: Significant improvement of quality of life over time is proved by both OHIP-14 and OQLQ in the present study. Socio-demographic and holistic considerations are important when evaluating treatment outcome after combined orthodontic and orthognatic surgery. However, longer follow-up would be beneficial. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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| 5. |
- Bergman, Annika, et al.
(författare)
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Germline mutation screening of the Saethre-Chotzen-associated genes TWIST1 and FGFR3 in families with BRCA1/2-negative breast cancer
- 2009
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Taylor & Francis. - 0284-4311 .- 1651-2073. ; 43:5, s. 251-255
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Tidskriftsartikel (refereegranskat)abstract
- Saethre-Chotzen syndrome is one of the most common craniosynostosis syndromes. It is an autosomal dominantly inherited disorder with variable expression that is caused by germline mutations in the TWIST1 gene or more rarely in the FGFR2 or FGFR3 genes. We have previously reported that patients with Saethre-Chotzen syndrome have an increased risk of developing breast cancer. Here we have analysed a cohort of 26 women with BRCA1/2-negative hereditary breast cancer to study whether a proportion of these families might have mutations in Saethre-Chotzen-associated genes. DNA sequence analysis of TWIST1 showed no pathogenic mutations in the coding sequence in any of the 26 patients. MLPA (multiplex ligation-dependent probe amplification)-analysis also showed no alterations in copy numbers in any of the craniofacial disorder genes MSX2, ALX4, RUNX2, EFNB1, TWIST1, FGFR1, FGFR2,FGFR3, or FGFR4. Taken together, our findings indicate that mutations in Saethre-Chotzen-associated genes are uncommon or absent in BRCA1/2-negative patients with hereditary breast cancer.
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| 6. |
- Bevilacqua, Ruggero, et al.
(författare)
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Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis
- 2018
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Ingår i: Journal of Craniofacial Surgery. - 1049-2275. ; 29:4, s. 920-924
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Tidskriftsartikel (refereegranskat)abstract
- Multisutural nonsyndromic craniosynostosis is a rare group of malformations, whose frequency has been reported between 3% and 7% of all craniosynostosis. The clinical diagnosis can be difficult and computed tomography is usually required. Surgical treatment is challenging and staged procedures are performed in up to 80% of patients. The aim of the present study was to determine the reoperation rate and to evaluate the surgical outcomes by measuring intracranial volume (ICV) preoperatively and at follow-up, and comparing it to a control group. Perioperative variables and reoperation rate were recorded. Fifty-one patients presented with a complex pattern of synostosis without a recognizable syndrome (5% of cases of total patients evaluated). Fifteen patients have been treated with spring-assisted surgery, either alone or in combination with a foreheadplasty. The mean follow-up was 6.2 years. The mean preoperative ICV of the patients was smaller, but not significantly, than in the normal population (P = 0.13). Postoperatively, the mean ICV was similar to that of the control group at 1 year (P = 0.92), while at 3 years it was appreciably smaller, although not significantly different (P = 0.06). Five patients (33%) went through a secondary skull expansion for either raised intracranial pressure or cosmetic reasons. Spring-assisted surgery seems to temporarily expand ICV in children with complex synostosis and lower the reoperation rate, thus reducing the need for a second procedure. A longer follow-up would be necessary to further investigate the effects of springs over time.
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| 7. |
- Steenfos, H, et al.
(författare)
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Skin expansion. Long term follow up of complications and costs of care.
- 1993
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - 0284-4311. ; 27:2, s. 137-41
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Tidskriftsartikel (refereegranskat)abstract
- To find out our rate of complications after tissue expansion, and the cost of treatment in terms of use of hospital resources and length of sick leave, we analysed our experience of 181 expansion treatments in 97 patients undertaken between 1986 and 1991. There were 60 women and 37 men, with a mean age of 22 (range 1-74). Twenty patients had more than one period of treatment (range 2-8). The most common conditions treated were naevi (n = 75); scars (trauma--n = 33, burns--n = 17, and operations--n = 16); and breasts that required reconstruction (n = 15). Of the 181 expansions there were 29 failures (16%), and 117 complete successes (64%); fifteen of the latter developed minor complications (8%), 35 were partly successful (20%). There were 77 complications in 71 treatments (38%), and 45 expanders (25%) had to be removed prematurely because of complications. The most common complications were skin penetration (n = 15), minor infection (n = 13), and breakdown of the surgical wound (n = 13). The median (range) inpatient hospital stay was 8 days (2-39); number of visits to the outpatient clinic for filling 7 days (0-20); and total treatment time/patient 82 (19-286). We conclude that skin expansion is a useful technique, but that there is room for improvement in reducing the rate of complications and the amount of time that patients spend being treated.
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| 8. |
- Selvaggi, Gennaro, 1973, et al.
(författare)
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Ethical Considerations in Surgery for Single-suture Craniosynostosis.
- 2023
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Ingår i: The Journal of craniofacial surgery. - 1049-2275 .- 1536-3732. ; 34:7, s. 1922-1926
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Tidskriftsartikel (refereegranskat)abstract
- Single-suture craniosynostosis (SSC) describes the premature fusion of one cranial suture, which restricts cranial growth and consequently results in unaffected regions presenting a compensatory expansion. Surgery can redistribute intracranial volume, reduce the risk of elevated intracranial pressure, and improve head shape, potentially leading to improved neurocognitive function and social acceptance. However, there is limited evidence that surgery for SSC improves neurocognitive function and social acceptance. Given the inherent surgical risks and uncertainty of outcomes, the conditions under which this surgery should be allowed remain uncertain. Here, we discuss ethical questions regarding the permissibility of surgery, value of neurocognitive function and social acceptance, research ethics associated with SSC, patient autonomy and parental roles, and the process of recommending surgery and obtaining consent. Because surgery for SSC has become a routine procedure, its practice now presents a relatively low risk of complications. Furthermore, having acquired an understanding of the risks associated with this surgery, such knowledge fulfils the principle of non-maleficence although not beneficence. Thus, we advocate that surgery should only be offered within Institutional Review Board-approved research projects. In these situations, decisions concerning enrollment in scientific research involves health care providers and parents or guardians of the child, with the former acting as gate-keepers upon recognition of a lack of coping skills on the part of the parent or guardian in dealing with unforeseen outcomes. To minimize associated surgical risks and maximize its benefits, there exists a moral obligation to refer patients only to highly specialized centers.
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| 9. |
- Tarnow, Peter, 1963, et al.
(författare)
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[Disaster planning--lessons learned from the fire disaster in Gothenburg]
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:4
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Tidskriftsartikel (refereegranskat)abstract
- The tragic fire disaster in Sweden 1998, killing 63 and wounding 213 teenagers was the result of arson fire in the basement of an overcrowded discotheque. Since the disaster occurred in a major city with substantial resources, all the injured could be hospitalised within two hours. The load on four local hospitals was initially severe due to the large number of injured. The patients suffered from inhalation injuries of different severity, whereas 25 of them also had deep skin burn injuries. Thirteen of the most severe burn injuries were transported to burn units in other parts of Sweden and to Norway. The vast psychosocial rehabilitation program initiated by health care staff, religious communions, schools and the community, has continued over the past years. This fire disaster emphasises the need for extensive preparation not only in the rescue and medical services, but also in many other areas of society.
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| 10. |
- Fogdestam, Ingemar, 1941, et al.
(författare)
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Extended free lateral arm flap with preservation of the posterior cutaneous nerve of the forearm.
- 1996
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - 0284-4311. ; 30:1, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- The free lateral arm flap has become a well-defined and reliable flap for various reconstructive purposes. Little attention has been paid, however, to the possibility of preservation of the posterior cutaneous nerve of the forearm (nervus cutaneus antebrachii posterior) sacrifice of which results in numbness of the dorsal part of the forearm. In this study, an anatomical dissection showed that in many cases it would be possible to preserve the nerve. We did 23 free lateral arm flaps in 22 patients during the period 1989-1994. The maximum flap length was 40 cm. Standard maximum width in most cases was 6 cm, and by using a new expansion technique it reached 10 cm in one case. Furthermore, with meticulous dissection the posterior cutaneous nerve of the forearm was either preserved or cut and rejoined in 21 patients, so minimising sensory loss at the donor site.
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