We thank Vergnaud et al.  for their interest in our publication.1We partly agree with them concerning the difference of blood loss in function of type of craniofacial malformation. Effectively, cranial malformation with multiple suture involvement requiring complex surgery has a lot of risk of substantial bleeding and transfusion requirements.2Nevertheless, surgery for multiple suture malformation is less common and, in our study, both groups were comparable concerning the type of malformations. The number of patients included in our study is low, but it relates statistically to the answer of our primary hypothesis. Sample-size calculation was evaluated by our institutional biostatistics department from the previous study of Helfaer et al .3We agree again that our results concerning blood loss are slightly different from Goobie's, but we used a lower tranexamic acid initial bolus. This probably explains the nonsignificant difference between our two groups. Goobie et al.  4used calculation of estimated erythrocyte volume lost to evaluate the intraoperative blood losses. Nevertheless, with strict hemodilution guidelines and the regular hematocrit measurements used in our study,1the evaluation of blood losses measured from surgical aspiration and weighing surgical sponges is a surrogate of erythrocyte volume losses. Moreover, concerning the transfusion threshold, in the study of Goobie et al. ,4the hematocrit threshold for packed erythrocytes transfusion was 25% and not 30% (estimated hemoglobin 7 to 8 g/dl), close to the threshold that we used in our study (hemoglobin: 7 g/dl).

We again thank Vergnaud et al.  for their interest in our publication and we encourage them to realize other studies with large homogenous series of children in this field to determine the real benefit of tranexamic acid: to limit transfusion requirements in major pediatric craniofacial surgery.

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Czerwinski M, Hopper RA, Gruss J, Fearon JA: Major morbidity and mortality rates in craniofacial surgery: An analysis of 8101 major procedures. Plast Recontsr Surg 2010; 126:181–6
Helfaer MA, Carson BS, James CS, Gates J, Della-Lana D, Vander Kolk C: Increased hematocrit and decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery. J Neurosurg 1998; 88:704–8
Goobie SM, Meier PM, Pereira LM, McGowan FX, Prescilla RP, Scharp LA, Rogers GF, Proctor MR, Meara JG, Soriano SG, Zurakowski D, Sethna NF: Efficacy of tranexamic acid in pediatric craniosynostosis surgery: A double-blind, placebo-controlled trial. ANESTHESIOLOGY 2011; 114:862–71