Review of the Use of Stainless Wires in Craniosynostosis Surgery

Background: Controversy exists as to the ideal form of bone fixation in craniosynostosis surgery with the use of resorbable plates predominating in most craniofacial units. However, the use of stainless steel wires has been the preferred fixation method at the Oxford Craniofacial Unit (OCU) since its establishment. Wires have the advantage of being malleable, inexpensive, and quick and easy to use. Methods: A retrospective review of all patients who underwent craniosynostosis surgery at the OCU between February 1995 and February 2017 was undertaken. Average follow-up period was 141 months (11.7 years), with a minimum of 6 months. Results: A total number of 1226 craniosynostosis procedures were performed. A minimum of 16,160 wires were inserted. No complications were identified resulting from transdural migration of wires. One hundred fifty-six wires were removed in 92 patients during 109 general anesthetic day-care procedures. This was due to discomfort on palpation in the majority of cases. The average time from primary surgery to removal of wires was 37 months (3.1 years). The most common site for wire removal was in the supraorbital and lateral forehead regions, and occurred most frequently in children who had undergone fronto-orbital advancement and remodeling. Conclusion: The use of wires in craniofacial surgery is safe. One percent of all wires that were inserted had to be removed. Children undergoing primary craniosynostosis surgery have a 9% chance of needing a subsequent day-care procedure to have a wire removed. Taking into account the cost of this additional surgical procedure, the primary use of wires in craniosynostosis surgery is still significantly cheaper than the use of resorbable plates. Address correspondence and reprint requests to Hamidreza Natghian, MD, Oxford Craniofacial Unit, Level LG1, West Wing, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK; E-mail: Hamidreza.natghian@gmail.com Received 8 May, 2018 Accepted 16 October, 2018 This work was presented at International Society of Craniofacial Surgery (ISCFS), October 24–28, 2017. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Hr5VNt