Correction of metopic synostosis utilizing an in situ bandeau approach.

Metopic craniosynostosis is a common growth disturbance in the infant cranium, second only to sagittal synostosis. Presenting symptoms are usually of a clinical nature and are defined by an angular forehead, retruded lateral brow, bitemporal narrowing, and a broad-based occiput. These changes create the pathognomonic trigonocephalic cranial shape. Aesthetic in nature, these morphological changes do not constitute the only developmental issues faced by children who present with this malady. Recent studies and anecdotal evidence have also demonstrated that children who present with metopic synostosis may face issues with respect to intellectual and/or psychological development. The authors present an elegant approach to the surgical reconstruction of the trigonocephalic cranium using an in situ bandeau approach.

A functional aesthetic approach to correcting the sequelae of sagittal synostosis.

Sagittal synostosis is the most commonly treated form of craniosynostosis exhibiting an incidence of 1:5000 births.(1) Early closure of the sagittal suture is the cause of the classic phenotypic presentation of an elongated head, which is characterized by a narrow and low occiput, a saddle-shaped parietal region, and noticeable frontal bossing. Early surgical intervention is the treatment of choice and surgical options range from simple suture excision to total cranial vault remodeling. Noting that a significant proportion of patients present with limited frontal bossing and asymmetry that is more pronounced in the posterior cranium, the author developed the functional aesthetic approach to reconstruction. This operative technique addresses the changes noted in the posterior two-thirds of the cranial vault, completely correcting the sequelae associated with early closure of the sagittal suture. As an added advantage, the reconstructive paradigm is designed to create a dynamic temporal-occipital component that will activate when a child rests in the supine position. This enhances widening of the posterior cranium thus improving long-term results.

Smile train: changing the world one smile at a time.

Smile Train was founded with one, clear aim--to help as many children as possible who are needlessly suffering with unrepaired clefts. Its unique "teach-a-man-to-fish" strategy supports local medical professionals to provide free, safe, and high-quality cleft care by offering free education and training opportunities, free equipment, and financial support for cleft treatment. Smile Train is continuing to expand its reach and enhance its ability to serve by developing and implementing new and innovative approaches in the delivery of comprehensive cleft care, so that each and every child born into the world with a cleft has the opportunity to live a full, productive life.

Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?

The management of long bone open extremity fractures has included initial wound cultures, antibiotics, operative debridement, and fracture repair, if indicated. The value of initial wound cultures is unclear. We examined whether primary wound cultures predict which wounds will become infected, and whether bacterial growth on primary wound cultures correlates with bacteria cultured from infected wounds. This prospective study involved patients presenting to a regional trauma center. Before any interventions were performed, initial aerobic and anaerobic cultures of the wounds of 117 consecutive open extremity fractures grades I-III were obtained. The results of these cultures were correlated with the development of a wound infection, and if an infection occurred, the organism grown from the infected wound was compared with any organism grown from the primary wound cultures. Of the initial cultures, 76% (89/117) did not demonstrate any growth, while the other 24% (28/117) only grew skin flora. There were only 7 (6%) wound infections, and 71% (5/7) initially did not grow any organisms. Of the isolates that grew from the initial cultures, none were the organisms that eventually led to wound infections. The use of primary wound cultures in open extremity injuries has no value in the management of patients suffering long bone open extremity fractures.