Meningomyelocele defect report: surgical technique selection

Abstract

Aims: Surgical repair of meningomyelocele is important in terms of infection, cerebrospinal fluid (CSF) leakage, and preservation of neural structures. While there are numerous techniques available for repair, there are few guidelines on when flap repair should be performed. In this study, we employed a method to select the surgical technique. Methods: Thirty-two patients with meningomyelocele who underwent surgery were included in the study. The decision to use or not to use a flap was based on the ratio of defect height to width and the ratio of the axillary line to defect width. Results: Fasciocutaneous transposition flap (FTF) repair was performed in 17 patients, whereas primary repair was performed in 15 patients. There was no statistically significant difference between the groups in terms of preoperative characteristics of the patients. In the FTF group, one patient experienced necrosis at the wound site, and one patient developed a cerebrospinal fluid fistula. In the primary repair group, necrosis was observed in one patient, CSF fistula developed in two patients, and central nervous system infection developed in one patient. No statistically significant difference was found between the groups in terms of complications. Conclusion: The results obtained in the present study suggest that the shape of the defect and the ratio of intact tissue to defect size are more important than the size of the defect itself in achieving appropriate tension during repair. By employing the patient selection guidelines we achieved successful outcomes using a different flap technique.