Closure Of Large Meningomyelocele Defects Research Articles

Corrigendum to: Reconstruction of Large Meningomyelocele Defects with Bipedicled Fasciocutaneous Flaps: Technical and Clinical Points.

The aim of this study was to evaluate the bilateral vertical bipedicled procedure for the closure of large meningomyelocele defects and to emphasise some technical and clinical considerations.This procedure was used to close large meningomyelocele defects in ten patients (six males and four females) between January 2016 and August 2020. Eight of the patients were operated on within the first 24 hours of birth, and the remaining two were operated on between 1-7 days from birth. The average defect size was 6 x 9 cm (5 x 7 and 8 x 13 cm). The location of the lesions was thoracolumbar in two patients and lumbosacral in eight patients. Patient demographics, including sex, gestational age, birth weight, age at operation, defect size, duration of the operation, intraoperative-postoperative blood transfusion, length of hospital stay and complications, were evaluated.In all patients, closure was successful. Two patients required reoperation because of wound dehis-cence, and healing was uneventful, without any complications. No patient experienced late breakdown of the wound during a mean follow-up period of 14.9 months (12-18 months).Bipedicled fasciocutaneous flaps can be used as an alternative method to repair large meningomyelo-cele defects due to their simple and reliable nature, which also causes less haemorrhage, and can be used in selected patients.

Reconstruction of Large Meningomyelocele Defects with Bipedicled Fasciocutaneous Flaps: Technical and Clinical Points.

The aim of this study was to evaluate the bilateral vertical bipedicled procedure for the closure of large meningomyelocele defects and to emphasise some technical and clinical considerations. This procedure was used to close large meningomyelocele defects in ten patients (six males and four females) between January 2016 and August 2020. Eight of the patients were operated on within the first 24 hours of birth, and the remaining two were operated on between 1-7 days from birth. The average defect size was 6 x 9 cm (5 x 7 and 8 x 13 cm). The location of the lesions was thoracolumbar in two patients and lumbosacral in eight patients. Patient demographics, including sex, gestational age, birth weight, age at operation, defect size, duration of the operation, intraoperative-postoperative blood transfusion, length of hospital stay and complications, were evaluated. In all patients, closure was successful. Two patients required reoperation because of wound dehis-cence, and healing was uneventful, without any complications. No patient experienced late breakdown of the wound during a mean follow-up period of 14.9 months (12-18 months). Bipedicled fasciocutaneous flaps can be used as an alternative method to repair large meningomyelo-cele defects due to their simple and reliable nature, which also causes less haemorrhage, and can be used in selected patients.

Closure of Large Myelomeningocele Defects Using the O-S Flap Technique

Meningomyelocele is a kind of spina bifida. In this deformity, the spinal canal and the back bone is open. This type of birth defect is also called a neural tube defect. There are many and different methods on the closure of large meningomyelocele defects. Although small meningomyeloceles may be agreeable to direct or primary closure with the local surrounding skin, the closure of large meningomyelocele skin defects needs more complex methods. The author presented a different surgical procedure for the closure of large meningomyelocele defects. The authors presented 9 neonates treated with an O-S (O is the shape of the defect, and S is the final scar shape) advancement procedure. After neurosurgical repair of the placode performed, the skin defect is closed with the O-S flap. This flap method is used for the closure of large meningomyelocele defects in 8 patients, aged between 4 days to 3 months. The defect size was 9.0 to 12.0 cm to 5.3 to 8.5 cm on an average. Mean follow-up was 9.25 months (range: 2-19 months). In all patients, there was no any flap ischemia, and the tension-free 1-stage closure was ensured. All patients healed without any complication. In one patient, cerebrospinal fluid leakage was observed. Revision surgery was done for this patient. No wound dehiscence was seen at follow-up period. The major advantages of this technique are: defects can be closed with only 2 incisions, short operative time, and there is no additional muscle transfer. Our suggested technique also provides a well-vascularized cutaneous tissue covering over the neural tissues. This suggested new technique seems to be a safe and practical solution for closure of the large meningomyelocele defects.

The reading man flap for closure of large meningomyelocele defects

Closure of the skin defect in myelomeningocele repair is an essential step that determines the quality of the surgical result. In large myelomeningoceles, however, adequate skin coverage may not be accomplished by direct closure or skin undermining. In such cases, the skin defect is best repaired using flaps. The aim of this study is to evaluate the reading man procedure for closure of large meningomyelocele defect. In this procedure, after neurosurgical repair and closure of the placode, the defect surgically becomes a circle in shape. Then, the circular defect is closed by transposition of two skin flaps designed in an unequal Z-plasty manner. Over 5 years, the reading man procedure was used for closure of large meningomyelocele defects in seven patients (four females and three males), aged between 1.5 and 6 months. The defect size was 10.5×7.25 cm (8.5×5.3 and 12.6×9.5 cm) on average. The localisation of the lesions was thoracolumbar in two patients and lumbosacral in five patients. In all patients, a successful tension-free one-stage closure was obtained without dog-ear formation. Except for one patient with minimal tip necrosis, healing was uneventful without any complications. There was no patient with late breakdown of the wound during 1.5 years (8 months-4 years) of mean follow-up. The reading man procedure enables the surgeon to achieve a tension-free defect closure of considerably large meningomyeleocele defects. Using two well-vascularised fasciocutaneous flaps, it provides a durable coverage and soft tissue padding over the neural tissues with no suture seam at midline. With these advantages, the Reading Man Procedure seems to be a useful and safe alternative for closure of large meningomyelocele defects.

A New Approach to Closure of Myelomeningocele Defect

Because myelomeningocele defects vary in size, shape, and location, no single procedure applies to all. A large number of techniques have been described for closing the back defects occurring after excision of the meningocele sac, but new studies focus more on simple, reliable, and versatile alternatives because large defect is a challenging problem for reconstruction. This study presented a new fasciocutaneous flap, called z advancement-rotation flap for the coverage of meningomyelocele defects with the successful outcomes of 11 patients. Meningocele defect is imagined as a rhombus shape placed vertically over the midline and accepted to have corners and angles of a rhombus, but any skin excision from the margins of the wound is not made for creating a defect, which will be completely similar to a rhombus so that its angles are obtuse and real appearance is elliptic or round. Flaps are elevated from both sides of the wound and can easily be advanced, then rotated to the midline, and the donor area can be primarily sutured with no complications. Defect sizes ranged from 7.5 x 6 to 12 x 9.5 cm, and mean operation time for flap elevation and closure was 29 minutes. Presented technique is not only simple, safe, and stable but also has got some more advantages such as short operation time because of easy dissection, minimal blood loss, and primary closure of the whole wound as well. It seems to be an alternative for safe, rapid, less bleeding, and easy surgery resulting in a solution for the closure of large meningomyelocele defects.

A New Technique for Closure of Large Meningomyelocele Defects

Although small meningomyeloceles may be amenable to direct closure by undermining of the surrounding skin, the closure of large meningomyelocele defects is a challenging reconstructive problem. Here, we present a new surgical procedure for the closure of large meningomyelocele defects. In this procedure, after neurosurgical repair and closure of the placode, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 3 years, this new technique, namely Mutaf triangular closure procedure, was used for the closure of large meningomyelocele defects in 5 patients, aged between 2 days to 6 weeks. The defect size was 10.4 x 7.5 cm on average. In all patients, a tension-free 1-stage closure was obtained. Except one with a minimal hematoma, all patients healed with no complication. There was no patient with late breakdown of the wound during 2 years of mean follow-up. Besides the 2 major advantages of short operative time and minimal blood loss, our technique provides a well-vascularized soft tissue padding over the neural tissues, and no suture line overlies the cord closure. With these advantages, this new technique seems to be a useful and safe solution for closure of large meningomyelocele defects.

Discussion of “A New Technique for Closure of Large Meningomyelocele Defects”

Discussion of “A New Technique for Closure of Large Meningomyelocele Defects”

Bilobed Fasciocutaneous Flap Closure of Large Meningomyeloceles

Closure of large meningomyelocele defects presents a challenging problem. In this paper, the procedure and outcome of bilobed fasciocutaneous flap closure of large meningomyeloceles have been discussed. Bilobed fasciocutaneous flap was used in 20 patients with large meningomyelocele defects, the largest of which was 77 cm2. A fasciocutaneous dissection was performed and the defect area was covered by tension-free closure. In the follow-up period of 6 weeks, partial flap loss in a patient and cerebrospinal fluid leak inferior to the flap in another 2 were observed. These patients recovered by dressing without flap loss. Utilization of bilobed flaps for closure of large meningomyelocele defects seems to be an effective and reliable procedure, with advantages of decreased operative time, minimal bleeding, the suture lines for dura and flap not superimposed, and low morbidity.

Closure of Meningomyelocele Defects With Bilateral Modified V-Y Advancement Flaps

Although several different methods were described in the literature, closure of large meningomyelocele defects presents a challenging problem. Wound dehiscence may lead to devastating complications. In this paper, the efficacy of the bilateral modified V-Y advancement flap procedure was investigated in terms of simplicity, donor-site morbidity, and reliability. The authors presented 10 neonates treated with a modified subcutaneous advancement procedure. Unlike the typical V-Y advancement techniques, the apical extensions of the "V" flaps were elevated based on the paraspinous perforators. A standard closure algorithm was not followed, as the well-vascularized apical extensions facilitated intraoperative decision making for the most appropriate adaptation pattern, depending on the size, shape, and localization of the defect. As well as that, transposition of these apical flaps to the defect site was further supported by the advancement of the V-Y flaps to decrease the tension along the closure. Mean follow-up period was 13.6 months (range 3-37 months), and no complications that might be attributable to the operative procedure were observed. Utilization of bilateral modified V-Y flaps for the closure of large meningomyelocele defects is a simple and effective procedure. Main advantages of the method described in this paper may be listed as follows: simplicity, reliability due to coverage of the defect with well-vascularized flaps, minimal bleeding, decreased operative time, and no donor-site morbidity.