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Add-on extended dorsal intercostal artery perforator/propeller (AOE-DICAP) flaps for the reconstruction of large thoracolumbar myelomeningocele defects

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Reconstruction of large thoracolumbar myelomeningocele defects poses a challenging problem. The classical dorsal intercostal artery perforator flap is increasingly used in the thoracolumbar myelomeningocele–defect reconstruction, and it may not suffice for large defects. We aimed to evaluate the efficacy, reliability and clinical outcomes of the add-on extended dorsal intercostal artery perforator/propeller (AOE-DICAP) flap for the reconstruction of large thoracolumbar myelomeningocele defects.

Methods

Between March 2015 and March 2019, we studied twelve infants (nine females and three males) with large thoracolumbar myelomeningocele defects who were reconstructed with AOE-DICAP flap.

Results

All flaps survived ultimately, except for one patient who had superficial epidermolysis at the distal 0.5 cm of the flap, and it healed well secondarily. One patient had a temporary cerebrospinal fluid leak. The average follow-up was 18.5 months, and the overall complication rate was 16%. There were no flap survival-related complications.

Conclusions

AOE-DICAP flap provides a reliable and stable cover and may be viable for large thoracolumbar myelomeningocele–defect reconstruction.

Level of evidence: Level IV, Therapeutic

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References

  1. Greenberg F, James LM, Oakley GP (1983) Jr Estimates of birth prevalence rates of spina bifida in the united sttes from computer – generated maps. Am J Obstet Gynecol 145:570–573

    Article  PubMed  CAS  Google Scholar 

  2. Lapid O, Rosenberg L, Cohen A (2001) Meningomyelocele reconstruction with bilobed flaps. Br J Plast Surg 54:570–572

    Article  PubMed  CAS  Google Scholar 

  3. El-khatib HA (2004) Large thoracolumbar myelomeningocele defects; incidence and clinical experiences with different modalities of latissimusdorsi musculocutaneous flap. Br J Plast Surg 57:411–417

    Article  PubMed  Google Scholar 

  4. Tenekeci G, Basterzi Y (2017) Reliability of extended dorsal intercostal artery perforator propeller flaps for reconstruction of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 70(1):60–66

    Article  PubMed  Google Scholar 

  5. Boucher F, Mojallal A (2013) Atlas des arteres perforantes de la peau du tronc et des members – Guide dans la realisation des lambeaux perforants. Ann Chir Plast Esthet 58:644–649

    Article  PubMed  CAS  Google Scholar 

  6. Prasad V, Almutairi K, Kimble FW et al (2012) Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study. J Plast Reconstr Aesthet Surg 65:1518–1524

    Article  PubMed  Google Scholar 

  7. Badran HA, El-Helaly MS, Safe I (1984) The lateral intercostal neurovascular free flap. Plast Reconstr Surg 73:17–25

    Article  PubMed  CAS  Google Scholar 

  8. Daniel RK, Kerrigan CL, Gard DA (1978) The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg 58:653

    Article  Google Scholar 

  9. Taylor GI, Minabe T (1992) The angiosome of the mammals and other vertebrates. Plast Reconstr Surg 89:181

    Article  PubMed  CAS  Google Scholar 

  10. Minabe T, Harii K (2007) Dorsal intercostal artery perforator flap: anatomical study and clinical applications. Plast Reconstr Surg 120:681

    Article  PubMed  CAS  Google Scholar 

  11. Balakrishnan TM, Ganesan K, Jaganmohan J (2018) add-on extended dorsal intercostal artery perforator propeller flap (AOE-DICAP) for the reconstruction of large posterior trunk defects, Global Journal for Research Analysis : Volume-7 | Issue-4 | April-2018

  12. Brunetti B, Tenna S, Poccia I, Persichetti P (2017) Propeller flaps with reduced rotational angles: clinical experience on 40 consecutive reconstructions performed at different anatomical sites. Ann Plast Surg 78(2):202–207. https://doi.org/10.1097/sap.0000000000000830

    Article  PubMed  CAS  Google Scholar 

  13. Imaizumi A (2018) Duplex ultrasonography – assisted freestyle pedicled perforator flaps for the repair of myelomeningocele defects. Ann Plast Surg 80:539–545

    Article  PubMed  CAS  Google Scholar 

  14. Teo TC (2010) The propeller flap concept. Clin Plast Surg 37:615–626

    Article  PubMed  Google Scholar 

  15. Balakrishnan TM, Gopalrathinam S, Jaganmohan J (2019) Ergonomics and biogeometry of free style pedicled perforator/propeller flaps in the reconstruction of soft tissue defects of lower limb. EC Orthop 10.5:256–270

    Google Scholar 

  16. Patterson TJ (1959) The use of rotation flaps following excision of lumbar myelomeningoceles; an aid to the closure of large defects. Br J Surg 46:606–608

    Article  PubMed  CAS  Google Scholar 

  17. Campobasso P, Pesce C, Costa L et al (2004) The use of the limberg skin flap for closure of large lumbosacral myelomeningoceles. Pediatr Surg Int 20:144–147

    Article  PubMed  Google Scholar 

  18. Zide BM (1990) Spina bifida. In: McCarthy JG (ed) Plastic surgery. Saunders, Philadelphia, pp 3780–90

    Google Scholar 

  19. Mustarde JC (1968) Reconstuction of the spinal canal in severe spina bifida. Plast Reconstr Surg 42:109–114

    Article  PubMed  CAS  Google Scholar 

  20. Gutierrez-Ontalvilla P, Blanco EL, Miranda P (2019) Long-term follow-up of myelomeningocele defect closure with dorsal intercostal artery perforator propeller flaps. Childs Nerv Syst 35(7):1219–1222

    Article  PubMed  Google Scholar 

  21. 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):434–437

    Article  PubMed  CAS  Google Scholar 

  22. Brunetti B, Tenna S, Aveta A, Poccia I, Segreto F, Cerbone V, Persichetti P (2016) Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: CLINICAL experience on 20 consecutive oncological cases. Microsurgery 36(7):546

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and faciomaxillary surgery, Madras Medical College, Chennai-3, 600003, India

    Thalaivirithan Margabandu Balakrishnan, ParimalaDevi Sengodan & J. Jagan Mohan

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  1. Thalaivirithan Margabandu Balakrishnan
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  2. ParimalaDevi Sengodan
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  3. J. Jagan Mohan
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Corresponding author

Correspondence to Thalaivirithan Margabandu Balakrishnan.

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Ethics approval

All the procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Madras Medical College Institutional ethical committee approved this clinical study (79/2014/PLS).

Conflict of interest

Dr. Thalaivirithan Margabandu Balakrishnan, Dr. ParimalaDevi Sengodan and Dr. J.Jagan Mohan declare no conflict of interest.

Patient consent

Informed consent was obtained from all the parents of children treated in the study, and signed informed consent regarding publishing their data and photographs was obtained.

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Balakrishnan, T.M., Sengodan, P. & Mohan, J.J. Add-on extended dorsal intercostal artery perforator/propeller (AOE-DICAP) flaps for the reconstruction of large thoracolumbar myelomeningocele defects. Eur J Plast Surg 45, 941–950 (2022). https://doi.org/10.1007/s00238-022-01960-3

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  • DOI: https://doi.org/10.1007/s00238-022-01960-3

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