A new approach to closure of myelomeningocele defect: z advancement-rotation flap.

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.