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At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help.
Craniofacial surgery is a type of plastic surgery that deals with the correction and reconstruction of malformations or problems of the skull. One of the most common conditions treated with craniofacial surgery is craniosynostosis (CRAY-nee-oh-SIN-oh-STO-sis), the early closing of the spaces between the bones of the skull, resulting in abnormal skull growth. The particular surgery to correct craniosynostosis is called a cranial vault remodeling.
A plan for craniofacial surgery may be put in place as early as 8 or 9 months of age, or as soon as the problem is recognized. Patients who are referred to the Cleft-Craniofacial Center at Children’s Hospital first receive a physical exam, followed by CT scans to confirm the diagnosis. An eye exam by a pediatric ophthalmologist (eye surgeon) should follow, in addition to a consultation with a pediatric neurosurgeon (brain surgeon). This team of doctors, along with the craniofacial surgeon, will map out the plan for your child’s reconstructive craniofacial surgery.
About 6 weeks before your child’s surgery, your child may begin blood enrichment therapy to build up the quality of his or her blood using medication. Once a week for 6 weeks, your child may receive an injection (shot) of erythropoietin (ProcritTM) to increase the number of red blood cells in his or her bloodstream. Your child also will be given iron supplements to help his or her body produce red blood cells. This blood therapy will reduce the need for blood transfusions during surgery and will help your child heal and recover faster after surgery.
In the 6 weeks leading up to the surgery, while your child is on the blood enrichment medication, your child will need to have a blood count done at 3 different points in the therapy process: at the start of the medication therapy, halfway through the therapy, and then at the end of therapy, prior to surgery. The blood test will determine your child’s blood type, a cross-matching blood type and a red blood cell count. In case your child needs a blood transfusion during the surgery, matching blood from the blood bank will be made available, or you and/or other family members may choose to donate matching blood instead. A cell-saver machine also will be used during your child’s surgery to minimize the need for a blood transfusion. The cell saver collects blood lost during the surgery, then cleans and returns it to your child’s body.
Several weeks before surgery you will meet again with your surgeon for a preoperative history and physical and to discuss the surgery.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.
For children older than 12 months:
For infants under 12 months:
For all children:
Your child will come to the Same Day Surgery Center of Children’s Hospital in Lawrenceville the morning of the surgery. When you have checked in at the Same Day Surgery Center, you and your child will be called to an examination room where your child’s health history will be taken and vital signs will be checked.
You will meet with one of the doctors on your child’s surgical team to go over the surgery. He or she will answer any last minute questions you might have at this time. A member of the anesthesia staff also will meet with you and your child to review his or her medical information and decide which kind of sleep medication he or she should get. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
When it is time for your child to go the operating room, you will be asked to wait in the surgical family waiting area.
To complete the craniofacial surgery, the surgeon must make an incision (in-SIZZ-yun) or cut in your child’s scalp to get to the skull bones. This incision will run from ear to ear, and will be a zig-zag rather than a straight incision. The zig-zag incision will allow your child’s hair to grow over the scar and make it less noticeable as it heals.
Your child will have sutures (SOO-chers) or stitches in his or her scalp to close the zig-zag incision. All of the sutures will be dissolvable, meaning that they will not need to be removed. As the skin heals, the parts of the sutures that are under the skin will dissolve on their own and will be absorbed into the skin. Any part of the suture that you can see on the top of the skin’s surface will dry up and fall off.
The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.
During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times, in case the family needs to be reached.
While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. To keep your child asleep during the surgery, he or she may be given anesthesia medication by mask, through the IV or both. When the surgery is over, the medications will be stopped and your child will begin to wake up.
When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up.
A complete list of instructions for taking care of your child at home will be given to you before you leave the hospital. The main things to remember are:
If your child has any special needs or health issues you feel the doctor needs to know about, or if you have any questions, please call 412-692-8650 before the surgery and ask to speak with the nurse practitioner or cleft clinic coordinator. It is important to notify us in advance about any special needs your child might have.
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
In addition to the main hospital, Children's has many convenient locations in other neighborhoods throughout the greater Pittsburgh region.
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