Tugay Atalay1, Kadir Oktay2, Ebru Guzel3, Lutfi Tekes4, Mehmet Solakhan5, Servet Ozkiraz6, Bahattin Celik7, Aslan Guzel8. 1. Department of Neurosurgery, Erciyes University School of Medicine, Kayseri, Turkey. 2. Department of Neurosurgery, Cukurova University School of Medicine, Saricam District, Balcali Campus, 01000, Adana, Turkey. drkadiroktay@hotmail.com. 3. Department of Radiology, Gaziantep Medical Park Hospital, Gaziantep, Turkey. 4. Department of Plastic and Reconstructive Surgery, Yuzuncu Yil University School of Medicine, Van, Turkey. 5. Department of Urology, Bahcesehir University School of Medicine, İstanbul, Turkey. 6. Department of Pediatrics, Division of Neonatology, Bahcesehir University School of Medicine, İstanbul, Turkey. 7. Department of Neurosurgery, Meydan Hospital, Sanliurfa, Turkey. 8. Department of Neurosurgery, Bahcesehir University School of Medicine, İstanbul, Turkey.
Abstract
PURPOSE: Of the many suggested techniques, we used dorsal intercostal perforator artery flap (DIPAF) for the closure of myelomeningocele defects. This study compared the outcomes of primary closure and DIPAF in the closure of myelomeningoceles. METHODS: Data of 24 patients that underwent myelomeningocele surgery at a single institution between November 2015 and September 2019 were retrospectively reviewed. RESULTS: The primary closure group had 13 patients (54.17%) and the DIPAF group had 11 (45.83%). The mean age was 7.91 ± 13.27 days (1-60 days). Twelve patients were female and 12 were male. In 22 patients, the myelomeningocele sacs were in the lumbosacral region, while in 2, they were in the thoracolumbar region. The mean defect sizes were 14.20 ± 4.62 cm2 and 18.44 ± 3.49 cm2 in the primary closure and DIPAF groups, respectively. In each group, four patients had a kyphotic deformity. In the primary closure group, three patients had wound necrosis, two had wound dehiscence, and four had cerebrospinal fluid (CSF) leakage. In the DIPAF group, one patient had wound necrosis and one had CSF leakage. Significantly fewer complications related to the operation area were observed in the DIPAF group (p < 0.05). Increased defect size, kyphotic deformity, and presence of hydrocephalus were found to be risk factors for complications related to the operation area. CONCLUSION: This surgical treatment protects neural tissue, prevent CSF leakage, and reduce central nervous system infection rates in myelomeningocele patients. Closure technique with the fasciocutaneous skin flap has more satisfying results than primary closure.
PURPOSE: Of the many suggested techniques, we used dorsal intercostal perforator artery flap (DIPAF) for the closure of myelomeningocele defects. This study compared the outcomes of primary closure and DIPAF in the closure of myelomeningoceles. METHODS: Data of 24 patients that underwent myelomeningocele surgery at a single institution between November 2015 and September 2019 were retrospectively reviewed. RESULTS: The primary closure group had 13 patients (54.17%) and the DIPAF group had 11 (45.83%). The mean age was 7.91 ± 13.27 days (1-60 days). Twelve patients were female and 12 were male. In 22 patients, the myelomeningocele sacs were in the lumbosacral region, while in 2, they were in the thoracolumbar region. The mean defect sizes were 14.20 ± 4.62 cm2 and 18.44 ± 3.49 cm2 in the primary closure and DIPAF groups, respectively. In each group, four patients had a kyphotic deformity. In the primary closure group, three patients had wound necrosis, two had wound dehiscence, and four had cerebrospinal fluid (CSF) leakage. In the DIPAF group, one patient had wound necrosis and one had CSF leakage. Significantly fewer complications related to the operation area were observed in the DIPAF group (p < 0.05). Increased defect size, kyphotic deformity, and presence of hydrocephalus were found to be risk factors for complications related to the operation area. CONCLUSION: This surgical treatment protects neural tissue, prevent CSF leakage, and reduce central nervous system infection rates in myelomeningocele patients. Closure technique with the fasciocutaneous skin flap has more satisfying results than primary closure.
Authors: Samuel C Lien; Cormac O Maher; Hugh J L Garton; Steven J Kasten; Karin M Muraszko; Steven R Buchman Journal: Childs Nerv Syst Date: 2010-03-02 Impact factor: 1.475