Patricia Gutierrez-Ontalvilla1, Eva Lopez Blanco2, Pablo Miranda3. 1. Unit of Plastic Pediatric Surgery, University Hospital La Fe, Valencia, Spain. patricia@dragutierrez.com. 2. Unit of Plastic Pediatric Surgery, University Hospital La Fe, Valencia, Spain. 3. Unit of Pediatric Neurosurgery, University Hospital La Fe, Valencia, Spain.
Abstract
BACKGROUND: Closure of the skin defect in myelomeningocele repair determines the quality of the surgical result. In large myelomeningoceles, the direct closure or by skin undermining may not be possible. In these cases, the skin defect must be closed using flaps to provide a tension-free and successful closure. METHODS: In this procedure, after neurosurgical repair and closure of the placode, the defect surgically becomes an ovoid in shape. Then, this defect is closed by transposition of two dorsal intercostal artery perforator propeller flaps. The defect size was > 5 cm in diameter. The localization of the lesion was lumbosacral. RESULT: A successful tension-free one-stage closure was obtained, without necrosis. Healing was uneventful without any complications and the coverage remained stable over 9 years with the child growth. CONCLUSION: The dorsal intercostal artery perforator propeller flap enables the surgeon to achieve a tension-free defect closure of considerably large myelomeningocele defects. This type of closure provides a durable coverage and a soft tissue padding over the neural tissues that persist with the child growth. The dorsal intercostal artery perforator propeller flap seems to be a useful closure of large myelomeningocele defects.
BACKGROUND: Closure of the skin defect in myelomeningocele repair determines the quality of the surgical result. In large myelomeningoceles, the direct closure or by skin undermining may not be possible. In these cases, the skin defect must be closed using flaps to provide a tension-free and successful closure. METHODS: In this procedure, after neurosurgical repair and closure of the placode, the defect surgically becomes an ovoid in shape. Then, this defect is closed by transposition of two dorsal intercostal artery perforator propeller flaps. The defect size was > 5 cm in diameter. The localization of the lesion was lumbosacral. RESULT: A successful tension-free one-stage closure was obtained, without necrosis. Healing was uneventful without any complications and the coverage remained stable over 9 years with the child growth. CONCLUSION: The dorsal intercostal artery perforator propeller flap enables the surgeon to achieve a tension-free defect closure of considerably large myelomeningocele defects. This type of closure provides a durable coverage and a soft tissue padding over the neural tissues that persist with the child growth. The dorsal intercostal artery perforator propeller flap seems to be a useful closure of large myelomeningocele defects.