The Journal of craniofacial surgery
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Multicenter Study
Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations.
Surgical care represents an important source of opioid prescribing and chronic use, but rates of prolonged opioid use following pediatric procedures remain unclear. The authors describe the rates and risk factors for new persistent opioid use in patients after common cleft operations. ⋯ New persistent opioid use occurs after cleft-related procedures and could lead to chronic use in children, adolescents, and young adults.
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Multicenter Study Comparative Study
Whole Blood in Pediatric Craniofacial Reconstruction Surgery.
Pediatric complex cranial vault reconstruction (CCVR) surgery is often associated with significant blood loss and transfusion. The authors recently changed our transfusion practice during CCVR to using whole blood (WB) instead of reconstituted blood (RB). The aim of this study was to assess the impact of this practice change. Our hypothesis was that replacement with WB would be as effective as RB for the outcomes of total perioperative blood donor exposures (BDEs) and the incidence of laboratory evidence of postoperative coagulopathy. ⋯ There was no postoperative coagulopathy in the WB cohort. Whole blood was also associated with significantly fewer perioperative BDEs. Whole blood appears to be as effective as RB for replacement of blood loss in craniofacial surgery.
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Multicenter Study
Pediatric National Surgical Quality Improvement Program: Useful for Quality Improvement in Craniosynostosis Surgery?
The American College of Surgeons and the American Pediatric Surgical Association collaborate to provide pediatric hospitals with multispeciality surgical outcomes data through the Pediatric National Surgical Quality Improvement Program (NSQIP Peds). The authors used this national multicenter database to describe 30-day outcomes from craniosynostosis surgery and identify associations with perioperative events and blood transfusion. Data from NSQIP Peds were used to describe children undergoing craniosynostosis surgery. ⋯ Perioperative adverse event rate was 3.15%. Duration of surgery and duration of anesthesia were significantly associated with blood transfusion. The authors identified opportunities for pediatric NSQIP database improvement.
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Case Reports Multicenter Study
Management of an unusual craniofacial impalement injury by a metallic foreign body.
Craniofacial penetrating injuries caused by foreign bodies other than bullets or glass from traffic crashes are quite rare. Hence, there is a lack of knowledge regarding systematic management strategies or analysis of complications for craniomaxillofacial surgeons. Between 2002 and 2010, 82 patients underwent surgery for penetrating craniofacial injuries in 2 craniomaxillofacial trauma centers. ⋯ Penetrating injuries in the head and neck regions are complicated. Although a multidisciplinary team approach was performed from initial management to outpatient management in patients with unusual impalement injuries, numerous postoperative complications still remained. Preoperative patient informed consent was important.
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Based on clinical experience, the senior author has become convinced that wounds produced to correct the deformities of patients with neurofibromatosis (NF-1) have produced remarkably good scars, the interesting feature being that progression to keloid or hypertrophic scar is rare. The other point noted was that this situation did not change, no matter the patient's race or skin color. There have been few reports describing or discussing this hypothesis. ⋯ Infection was also noted in four cases. However, no patient developed hypertrophic scar or keloid in the neurofibromatosis group, whereas two cases showed hypertrophic scar in the solitary neurofibroma group. The outcome showed that the patients with NF-1 and plexiform neurofibroma, no matter the racial group, produce good scars without keloid or hypertrophic changes, whereas solitary neurofibroma has a potential to cause hypertrophic scar.