Introduction: Although regarded as conservative treatment, casting is not without risk. Injuries may be sustained during application, during cast valving, through the immobilization process, or during cast removal. We developed an experimental model to investigate safe parameters for the appropriate length of time between fiberglass cast application and bivalving for cast saw use. Methods: A hospital sheet was rolled into a mock "arm" on which short-arm fiberglass casts were formed. An appropriate cast saw technique was used with complete withdrawal of the saw blade from the cast material between cuts. A total of 10 casts were made for control/no vacuum (N = 5) and study/vacuum (N = 5) groups. The temperature of the saw blade was measured at 1-minute increments beginning at 3 minutes after fiberglass submersion in water. A mixed factor analysis of variance assessed differences in temperature change over time between groups with a statistical threshold of P , 0.05. Results: Casts that set for 7 minutes were associated with lower blade temperatures compared with casts that set for 3, 4, 5, and 6 minutes. The average temperature increases for the 3-to 7-minute set times without the use of vacuum were 10.08 (6 1.42), 9.38 (61.31), 9.32 (61.85), 8.54 (62.10), and 5.62°F (62.42), respectively, and with the use of vacuum, they were 9. 40 (61.14), 8.36 (61.64), 7.84 (62.05), 7.30 (63.14), and 4.82°F (62.59), respectively. Independent of vacuum use, the change in temperature was significantly different from the maximum temperature (3 minutes) beginning at 7 minutes (all P , 0.043). Discussion: A minimum of 7 minutes of set time for a fiberglass cast before attempting to bivalve using segmented cuts is associated with the smallest increase in temperature of the saw blade. Blade temperature was not affected with the vacuum enabled. Clinicians can demonstrate best practices to minimize the risk of cast saw injuries.

Craniosynostosis, a deformity of the skull caused by premature fusion of ≥1 cranial sutures, is treated surgically via endoscopic approaches or cranial vault remodeling. Postoperative infection is rare. Management of postoperative surgical site infections often involves culture-directed intravenous antibiotics and debridement, with removal of osteomyelitic bone and hardware in refractory cases. Removal of autologous bone in a pediatric patient presents a reconstructive challenge, as alloplastic options are not optimal in a growing child, especially in the setting of infection. Moreover, infants and small children have limited autologous bone options for reconstruction. We present our case of a young child who developed an infectious complication following cranial vault remodeling. The patient's demographic information, clinical presentation and postoperative course, radiologic features, surgical interventions, and treatment outcomes were reviewed. In our case, autologous osteomyelitic bone underwent tissue processing to eradicate the infection and complete skull reconstruction using the patient's own processed autologous bone was performed in a delayed fashion. The patient is now 1 year postoperative with no recurrence of infection. We present this case as a novel technique to eradicate infection in autologous bone, allowing for delayed autologous cranial reconstruction.

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