Reversed latissimus dorsi muscle flap versus skin flaps in closure of myelomeningocele defects: Comparative study

Abstract

In cases of closure of myelomeningocele defects, soft tissue coverage is needed as soon as the dural closure has been achieved. Small myelomeningocele defects can be managed by undermining ofthe surrounding skin but in the cases of large thoracolumbar or lumbosacral defects local flaps (skin or muscle flaps) are widely used. Purpose: To compare between two surgical techniques in repair of large myelomeningocele defects with muscle flaps and skin flaps in the different aspects and to provide a durable, protective, and tension-free soft tissue covering. Methods: We presented a review of our 3-year experience using this approach for closure of myelomeningocele. Our study included 10 consecutive patients treated using reversed latissimus dorsi muscle flap (group A) and other 10 cases treated with skin flaps (group B) for reconstruction of the myelomeningocele defects. Results: In all patients operated on a tension free closure was obtained. Complications developed in cases covered with skin flaps were one hematoma, one subclinical infection and 3 wound dehiscence while there was only one case that developed hematoma after coverage with reversed latissimus dorsi flaps. There was no patient with late breakdown ofthe wound during 2 years of mean follow-up. Conclusion: Instead of less donor site morbidity the skin flaps have higher operative complication rate (dehiscence, hematoma and subclinical infection) than with reversed latissimus dorsi flaps, so we can conclude that reversed latissimus dorsi flaps are still preferred to skinflaps in closure of large myelomeningeocele defects.