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Long-term follow-up of myelomeningocele defect closure with dorsal intercostal artery perforator propeller flaps

  • Patricia Gutierrez-Ontalvilla
  • Eva Lopez Blanco
  • Pablo Miranda
Case Report
  • 9 Downloads

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.

Keywords

Myelomeningocele Propeller flap Dorsal intercostal artery flap 

Notes

Compliance with ethical standards

Conflict of interest

N/A

Disclaimer

None of the authors has a financial interest in any of the products, devices or drugs mentioned in this article.

References

  1. 1.
    Reigel DH (1996) Myelomeningocele. In: Cheek WR (ed) Atlas of pediatric neurosurgery, 1st edn. W.B. Saunders, Philadelphia, p 1e9Google Scholar
  2. 2.
    Basterzi Y, Tenekeci G (2016) Dorsal intercostal artery perforator propeller flaps: a reliable option in reconstruction of large meningomyelocele defects. Ann Plast Surg 76(4):434e7CrossRefGoogle Scholar
  3. 3.
    Isik D, Tekes L, Eseoglu M et al (2011) Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg 67:159e63CrossRefGoogle Scholar
  4. 4.
    Mutaf M, Sunay M, Bulut Ö (2008) The “reading man” procedure a new technique for the closure of circular skin defects. Ann Plast Surg 60:420e5Google Scholar
  5. 5.
    Mutaf M, Temel M, Günal E (2012) The reading man flap for closure of large meningomyelocele defects. J Plast Reconstr Aesthet Surg 65:578e83CrossRefGoogle Scholar
  6. 6.
    Campobasso P, Pesce C, Costa L et al (2004) The use of Limberg skin flap for closure of large lumbosacral myelomeningoceles. Pediatr Surg Int 20:144e7CrossRefGoogle Scholar
  7. 7.
    Lapid O, Rosenberg L, Cohen A (2001) Meningomyelocele reconstruction with bilobed flaps. Br J Plast Surg 54:570e2CrossRefGoogle Scholar
  8. 8.
    McCraw JB, Penix JO, Freeman BG et al (1987) Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps. Ann Plast Surg 18:147e55Google Scholar
  9. 9.
    Sarifakioglu N, Bingul F, Terzioglu A et al (2003) Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects. Br J Plast Surg 56:303e6Google Scholar
  10. 10.
    Isik D, Tekes L, Eseoglu M, Isik Y, Bilici S, Atik B (2011) Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg 67(2):159-163Google Scholar
  11. 11.
    Duffy FJ Jr, Weprin BE, Swift DM (2004) A new approach to closure of large lumbosacral myelomeningoceles: the superior gluteal artery perforator flap. Plast Reconstr Surg 53:305e10Google Scholar
  12. 12.
    Mangels KJ, Tulipan N, Bruner JP et al (2000) Use of bipedicular advancement flaps for intrauterine closure of myeloschisis. Pediatr Neurosurg 32:52e6Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Plastic Pediatric SurgeryUniversity Hospital La FeValenciaSpain
  2. 2.Unit of Pediatric NeurosurgeryUniversity Hospital La FeValenciaSpain

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