Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects - A case report

Abstract

IntroductionMyelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, keystone island flap can be used for closure of large MMCs. Presentation of caseA new-born girl born as a product of 36 weeks of gestation had a weight of 3.020 kg and had multiple congenital anomalies including hydrocephalus, thoracolumbar myelomeningocele at the level of (T10-L4) and an atrial septal defect. Preoperative evaluation showed a head circumference of 42 cm (n: mean 34.4 ± 2SD), no lower limbs movements and a thoracolumbar soft tissue defect around 4 × 8 cm with exposed neuronal tissue and prominent thoracic kyphosis, and no obvious urogenital or limbs anomalies. The large thoracolumbar myelomeningocele was treated at KFSHRC with a Keystone Design Perforator Island Flap (KDPIF) to reconstruct the soft tissue defect following the neurosurgical reconstruction. DiscussionThe keystone flaps were deemed as viable as all wounds were healed without any complications, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers a simple and effective method of wound closure in situations that would, otherwise, have required complex flap closure. ConclusionThis flap can be an effective method for reconstruction of large thoracolumbar MMC defects that might improve outcome and minimize complications. It also ensures good watertight closure with minimal wound tension and breakdown.