PURPOSE: A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size. METHODS: We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect. RESULTS: Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis. CONCLUSIONS: Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair.
PURPOSE: A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size. METHODS: We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect. RESULTS:Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis. CONCLUSIONS: Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair.
Authors: Laura C Randolph; Julie Barone; Juan Angelats; Diane V Dado; Darl K Vandevender; Margo Shoup Journal: Plast Reconstr Surg Date: 2005-10 Impact factor: 4.730
Authors: Christopher Donaldson; Hamsaveni K M Murday; Matthew J Gutman; Rory Maher; Tony Goldschlager; Chris Xenos; R Andrew Danks Journal: Childs Nerv Syst Date: 2017-12-18 Impact factor: 1.475
Authors: Matthew J Gutman; Tony Goldschlager; Rostam D Fahardieh; David Ying; Chris Xenos; R Andrew Danks Journal: Childs Nerv Syst Date: 2011-04-19 Impact factor: 1.475
Authors: Liv Schoellhammer; Gudrun Gudmundsdottir; Mikkel M Rasmussen; Puk Sandager; Martin Heje; Tine Engberg Damsgaard Journal: JPRAS Open Date: 2018-05-31