Differences in Scalp Tension Associated with Craniosynostosis among Patients of Different Races

Background: Fronto-orbital advancement (FOA) is the gold standard treatment for craniosynostosis. Although FOA by gradual distraction has been practiced in Asia, it has not yet been accepted in Western countries. This may be attributable to differences in scalp tension among patients. Patients and Methods: The extent of skin advancement was intraoperatively measured as skin tension among 12 European (France) and 16 Asian (Japan) patients older than 6 months (age, 9.63±3.78 y) who underwent cranioplasty. Skin tension was measured at 3 points (left, right, and middle) after a zigzag bicoronal incision was made. Results: The skin tension measurements of European patients were as follows: left, 23.1±6.37 mm; middle, 18.5±3.85 mm; and right, 23.3±6.31 mm. Tension in the middle was significantly lower than that on the left and right (P<0.05). In contrast, the skin tension measurements of Asian patients were as follows: left, 12.8±1.49 mm; middle, 14.4±3.60 mm; and right, 13.0±1.74 mm. Tension in the middle was significantly higher than that on the left and right (P<0.05). In addition, skin tension was higher among European patients than among Asian patients. Conclusions: Scalp tension differed according to race. This should be considered when selecting appropriate treatment.