Object This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis. Methods Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed. Results There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery. Conclusions Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.

Nonsyndromic craniosynostosis is often associated with cognitive, speech, and/or behavioral abnormalities. The etiopathology of this association is unknown. Furthermore, the proportion of children diagnosed with cognitive and behavioral dysfunction increases with age. Therefore, longitudinal cognitive, behavioral, and speech assessment and treatment are integral to the care of these patients.

This case describes the use of the medial plantar artery flap used to cover a lateral foot wound in a 19‐year‐old male with a history of spina bifida. The original operative plan was for coverage with a medial plantar flap based distally on retrograde flow through the lateral plantar artery; however, this had to be revised intraoperatively as his vascular anatomy was not adequate to support a flap of this type. Thus, advancement with rotation modification of the conventional medial plantar flap was performed with good results. At 2‐month follow‐up, the patient's flap had fully healed, he returned to full weight‐bearing status, and he had gross sensation in the sole of his foot. This case illustrates the use of the well‐described medial plantar flap by rotating and advancing the flap for reconstruction of defects of the foot. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

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.Purpose. is study examines whether the use of elbow restraints aer cle lip/palate repair has a relationship to postoperative complications. Methods. A comparative descriptive design was used to study a convenience sample of children undergoing repair of cle lip/palate at Akron Children's Hospital with Institutional Review Board approval. e children were randomized into intervention or control groups with use of elbow restraints considered the intervention. e study consists of two arms; one examined children aer cle lip repair, the second examined children aer cle palate repair. Repairs were performed by a single surgeon. Data collected included age, comorbidities, patient discomfort measured by pain score, frequency and duration of pain medications, use of paci�er or �nger/thumb sucking, and postoperative complications including disruption of the suture line. Results. With 47 post palate repair patients and 47 post cle repair patients, there is no signi�cant difference � > 0.05) in the occurrence of postoperative complications. Conclusions. Study results provide prospective evidence to support postoperative observation of children by surgery staff and family following cle lip or cle palate repair without the use of elbow restraints. Clinicians should reevaluate the use of elbow restraints aer cle lip/palate repair based on the belief restraints prevent postoperative complications.