Why is this surgery done?
Skull reconstruction is done most commonly to treat a condition called craniosynostosis. This is a birth defect that occurs when one or more of the joints between the bones in a baby’s skull close too soon. These joints are called sutures. Open sutures let the skull expand as the baby’s brain grows. If one of more of these sutures closes early, it can cause an abnormal head shape. In severe cases, this can also cause increased pressure on the growing brain. Surgery is done to expand and reconstruct the skull. Most operations are done during infancy when the baby is between three to eight months of age. Some children require re-operation when they are older, as well.
How is the surgery done?
Surgery is done by a pediatric neurosurgeon and a plastic surgeon, in most cases. The surgery is done using anesthesia and usually lasts 4 – 8 hours, depending on the type of repair that is needed. Your baby may need to have a small strip of hair shaved from ear to ear at the top of the head. Most of the time, this will be your baby’s first haircut, so we always save the shaved hair for you. A wavy incision is made so that it hides well in your baby’s hair once it grows back. The skull bones are carefully removed by the neurosurgeon. The neurosurgeon and plastic surgeon work together to reshape the bones to give the baby a more normal head shape. The bones are put back together using very small reabsorbable plates and screws that typically go away on their own after about one year. The skin is closed in layers with stitches on the inside and outside. Most of the time the stitches are dissolvable, meaning they go away on their own and do not need to be removed. We will also wrap your baby’s head with a gauze bandage to help with swelling and healing. This is usually removed two days after surgery.
What are my risks? What are common complications?
As with any surgery, there are risks. Because the scalp and skull have a lot of tiny blood vessels, bleeding can happen. The surgeons are very careful to prevent bleeding, but oftentimes babies need a blood transfusion during surgery because their blood volume is so small. Because of this, we will be sure to have blood available during surgery as needed. Swelling and bruising can also happen after surgery. This usually starts to improve around 3 – 4 days after surgery and can take 3 – 6 months to go away completely. Due to swelling, your child might look different than you’re used to for a little while.
Other less-common postoperative complications include problems with wound healing and infection.
What do I need to know before surgery?
The surgeons operating on your baby are specially trained to do these types of surgeries. We know it can be a scary time, and we have a team of medical people who are available to answer any questions you might have.
About a month before surgery, you will come to the hospital (the same area where you will go the day of surgery) for a blood draw. This helps us be prepared in case your baby needs a blood transfusion during the surgery. Our office will call two days before the surgery to confirm your baby’s medications and health history, and give you specifics about where to go and when to arrive and when your child should stop eating and drinking.
Your baby will spend one night in the pediatric intensive care unit (PICU) and then two additional nights on a regular pediatric floor. Two adults are usually allowed to stay in the room (unless visitor restrictions are in place). The total hospital stay is generally three days.
The craniofacial team, which includes the pediatric neurosurgery and pediatric plastic surgery providers at Peyton Manning Children’s Hospital, are specially trained on this diagnosis and are experts in the care of skull reconstruction for craniofacial abnormalities/craniosynostosis.
General discharge instructions
If skin glue (also called Dermabond) was used, this will fall off in about 2 – 3 weeks. Do not apply oils, lotions or creams to the glue or the area surrounding the incision. Do not allow your child to peel or pick at the glue. The glue may curl at the edges and peel as it falls off naturally. If the edges curl, you may carefully trim the curled edges with nail clippers. Make sure they are clean before use.
If non–absorbable sutures were used, these need to be removed 2 – 3 weeks after surgery.
The incision should be kept completely dry the first five days after surgery.
No swimming in lakes, oceans, hot tubs or soaking in baths until the incision has healed completely and looks like a scar (about 2 months). Your child may swim in a clean (not public) chlorinated pool four weeks after surgery.
Your child may bathe five days after surgery. Allow soap and water to gently run over the incision, then pat dry with a clean towel or cloth. Be sure to rinse with clean water fresh from the faucet. Do not submerge the incision in bath water until the incision looks like a scar and is scab free.
Your child was likely sent home with the following medications: hydrocodone (lortab), zofran (ondansetron) and MiraLax.
Fortunately, you can treat your baby as you normally would before their surgery. As always, use caution to prevent them from being hit in the head with any firm objects. Never leave your infant unattended, even for a second, on a raised surface as they may roll over/off causing injury.
Continue playing with your baby and encouraging them to explore and learn new skills as you would have before surgery. Babies are resilient and most bounce back very quickly.
When to call our office:
- If your child has signs or symptoms of infection: incision redness or drainage, pain not relieved by medications or fevers over 100.5°F
- Difficulty with bowel or bladder function despite stool softeners and laxatives
- If you are not able to console your baby and feel their pain is not controlled with pain medication
Your follow-up appointment should be listed on your hospital discharge paperwork. If you need to reschedule or have questions, please call our office at (317) 338-0900.
What should I expect while recovering?
Routines and consistency are important for babies, and being in the hospital can disrupt your baby’s routine.
It is not uncommon for babies to want to be held or cuddled more for the first few weeks after surgery. It is important to differentiate pain from needing comfort. If you are able to console your baby by holding them, they typically are not in pain. If you’re not able to calm your baby by feeding, changing or holding them, then they are likely in pain.
Because your routine has been disrupted, your baby’s sleep schedule may be off or they may wake more often during the night. Again, most times babies just need some extra love and comfort, and this will get better with time.
It can take 3 – 6 months for swelling of their head and face to go away completely.