Local and Regional Flap Closure in Myelomeningocele Repair: a 15-year Review

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2010 Mar 3

PMID 20195618

Citations 12

Authors

Samuel C Lien

Cormac O Maher

Hugh J L Garton

Steven J Kasten

Karin M Muraszko

Steven R Buchman

Affiliations

Soon will be listed here.

Abstract

Purpose: A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size.

Methods: We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect.

Results: Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis.

Conclusions: Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair.

Citing Articles

Long-term follow-up of keystone perforator island flap in reconstructed myelomeningocele defects.

Kelly T, Leong J JPRAS Open. 2023; 38:261-268.

PMID: 37965636 PMC: 10641560. DOI: 10.1016/j.jpra.2023.09.008.

Myelomeningocele Closure: An Embryological Perspective.

Dias M, Lane J Cureus. 2020; 12(8):e9682.

PMID: 32923275 PMC: 7486018. DOI: 10.7759/cureus.9682.

Layered Closure of Lumbosacral Myelomeningocele Defects with Bilateral Paraspinous Muscle and Composite Fasciocutaneous Flaps.

Holoyda K, Kim E, Tuncer F, Maglic D, Hosein R, Kestle J Plast Reconstr Surg Glob Open. 2020; 8(6):e2884.

PMID: 32766049 PMC: 7339367. DOI: 10.1097/GOX.0000000000002884.

Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair.

Atalay T, Oktay K, Guzel E, Tekes L, Solakhan M, Ozkiraz S Childs Nerv Syst. 2020; 37(1):229-233.

PMID: 32666153 DOI: 10.1007/s00381-020-04796-z.

Risk factors, presentation and outcome of meningomyelocele repair.

Rehman L, Shiekh M, Afzal A, Rizvi R Pak J Med Sci. 2020; 36(3):422-425.

PMID: 32292446 PMC: 7150388. DOI: 10.12669/pjms.36.3.1237.

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