A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis.

INTRODUCTION: The craniofacial asymmetry seen in unilateral lambdoid craniosynostosis may not be effectively treated by posterior cranial vault remodeling, endoscopic suturectomy, and helmet therapy, or suturectomy and distraction osteogenesis alone due to limitations in soft-tissue envelope expansion and relapse of the deformity. The authors report a series of unilateral lambdoid craniosynostosis patients treated with a posterior rotational cranial-flap technique using internal distraction osteogenesis. METHODS: Posterior cranial vault reconstruction combined with internal distraction was used, aided by preoperative virtual surgical planning. An in situ posterior rotational flap osteotomy was utilized to maximize dural preservation. Primary outcome measures included age-adjusted volume change and age-adjusted percent volume change per mm distraction. Distraction characteristics and perioperative characteristics were also assessed. RESULTS: A total of 5 patients were identified. Mean predistraction intracranial volume was 1087.5 cc (SD  = 202.3 cc) and mean postdistraction included intracranial volume was 1266.1cc (SD  = 131.8cc). Mean age-adjusted percent included intracranial volume change was 14.1% (SD  = 9.6%), and mean percent intracranial volume change per mm distraction was 0.43%/mm distraction (SD  = 0.37%/mm distraction). One patient developed a distractor site infection postoperatively that was treated successfully with oral antibiotics. All patients had a Whitaker score of 1 at one year follow up. CONCLUSIONS: Posterior cranial vault remodeling using osteogenesis and a rotational cranial flap technique with dural preservation can be effectively used to maximize bone flap viability and limit postoperative relapse in patients with unilateral lambdoid craniosynostosis. Long term analysis as well as comparison to open techniques will need to be interrogated.

A simplified methodology for identifying the function of elopement.

Functional analyses of elopement (i.e., leaving a specific area without permission) are challenging to conduct because clients must have repeated opportunities to elope from one room (or area) to another safely. These analyses often require two or more adjoining rooms and retrieval of the client following each instance of elopement (e.g., Piazza et al., 1997). These room arrangements may be impractical in some settings, and therapist delivery of attention or demands during retrieval may confound the results. To address these issues, we evaluated the viability of conducting a functional analysis (FA) of elopement within a single room. Participants were 2 children and 2 adults with developmental disabilities who eloped from rooms at their day programs. Results of the single-room assessments were compared to those of a second FA that was conducted using methods similar to those described in previous studies. Function-based treatments were implemented for each participant. Results suggest that the single-room assessment may be a viable alternative for identifying the function of elopement.