Large thoracolumbar meningomyelocele defects: incidence and clinical experiences with different modalities of latissimus dorsi musculocutaneus flap.

In this study, we report a series of large thoracolumbar meningomyelocele (MMS) defects. The total incidence per 1000 live birth is 0.6, the male incidence per 1000 live birth is 0.56, and the female incidence per 1000 live birth is 0.47. The study was conducted on 23 infants, all suffered from large thoracolumbar MMC defects, and our treatment techniques are modifications of procedures previously described. The timing of surgery ranged between 2 and 5 days after birth, and the follow-up was ranged between 3 and 7 years. Different modalities were used for reconstruction: bilateral proximally based skin island, muscle pedicle latissimus dorsi (LD), myocutaneous flap (seven patients), bilateral bipedicled LD, myocutaneous flaps (nine patients), and distally based skin island, muscle pedicle LD, myocutaneous flaps (seven patients). All the patients tolerated procedures smoothly, and because LD muscle may be important for mobility in a potentially paraplegic wheelchair-bound patient, the author presents some modifications in order to preserve the muscle function. Criteria for flap selection will be discussed.