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Local and regional flap closure in myelomeningocele repair: a 15-year review

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Abstract

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.

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References

  1. Arad E, Barnea Y, Gur E, Amir A, Leshem D, Zaretski A, Rochkind S, Beny L, Constantini S, Weiss J (2006) Paravertebral turnover flaps for closure of large spinal defects following tethered cord repair. Ann Plast Surg 57:642–645

    Article  CAS  PubMed  Google Scholar 

  2. Baglaj M, Ladogorska J, Rysiakiewicz K (2006) Closure of large myelomeningocoele with Ramirez technique. Childs Nerv Syst 22:1625–1629

    Article  PubMed  Google Scholar 

  3. Blaiklock CR, Demetriou EL, Rayner CR (1981) The use of a latissimus dorsi myocutaneous flap in the repair of spinal defects in spina bifida. Br J Plast Surg 34:358–361

    Article  CAS  PubMed  Google Scholar 

  4. Campobasso P, Pesce C, Costa L, Cimaglia ML (2004) The use of the Limberg skin flap for closure of large lumbosacral myelomeningoceles. Pediatr Surg Int 20:144–147

    Article  PubMed  Google Scholar 

  5. Cole P, Armenta A, Dauser R, Hollier L Jr (2008) Simplifying soft tissue closure of the large meningomyelocele defect: a technical note. J Plast Reconstr Aesthet Surg 61:192–194

    Article  PubMed  Google Scholar 

  6. Cruz NI, Ariyan S, Duncan CC, Cuono CB (1983) Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note. J Neurosurg 59:714–717

    Article  CAS  PubMed  Google Scholar 

  7. Danish SF, Samdani AF, Storm PB, Sutton L (2006) Use of allogeneic skin graft for the closure of large meningomyeloceles: technical case report. Neurosurgery 58:ONS-E376

    Article  PubMed  Google Scholar 

  8. de Chalain TM, Cohen SR, Burstein FD, Hudgins RJ, Boydston WR, O’Brien MS (1995) Decision making in primary surgical repair of myelomeningoceles. Ann Plast Surg 35:272–278

    Article  PubMed  Google Scholar 

  9. 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 114:1864–1870

    Article  PubMed  Google Scholar 

  10. Fiala TG, Buchman SR, Muraszko KM (1996) Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery 39:522–526

    Article  CAS  PubMed  Google Scholar 

  11. Hayashi A, Maruyama Y (1991) Bilateral latissimus dorsi V-Y musculocutaneous flap for closure of a large meningomyelocele. Plast Reconstr Surg 88:520–523

    Article  CAS  PubMed  Google Scholar 

  12. Hosseinpour M, Forghani S (2009) Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps. J Neurosurg Pediatr 3:331–333

    Article  PubMed  Google Scholar 

  13. Jaworski S, Dudkiewicz Z, Lodzinski K, Lenkiewicz T (1992) Back closure with a latissimus dorsi myocutaneous flap. J Pediatr Surg 27:74–75

    Article  CAS  PubMed  Google Scholar 

  14. Lanigan MW (1993) Surgical repair of myelomeningocele. Ann Plast Surg 31:514–521

    Article  CAS  PubMed  Google Scholar 

  15. Luce EA, Walsh J (1985) Wound closure of the myelomeningocoele defect. Plast Reconstr Surg 75:389–393

    Article  CAS  PubMed  Google Scholar 

  16. McCraw JB, Penix JO, Freeman BG, Vincent MP, Wirth FH (1987) Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps. Ann Plast Surg 18:147–155

    Article  CAS  PubMed  Google Scholar 

  17. Mowatt DJ, Thomson DN, Dunaway DJ (2005) Tissue expansion for the delayed closure of large myelomeningoceles. J Neurosurg 103:544–548

    PubMed  Google Scholar 

  18. Mustarde JC (1966) Meningomyelocele: the problem of skin cover. Br J Surg 53:36–41

    Article  CAS  PubMed  Google Scholar 

  19. Ohtsuka H, Shioya N, Yada K (1979) Modified Limberg flap for lumbosacral meningomyelocele defects. Ann Plast Surg 3:114–117

    Article  CAS  PubMed  Google Scholar 

  20. Ozcelik D, Yildiz KH, Is M, Dosoglu M (2005) Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques). Neurosurg Rev 28:218–225

    Article  PubMed  Google Scholar 

  21. Perry VL, Albright AL, Adelson PD (2002) Operative nuances of myelomeningocele closure. Neurosurgery 51:719–724

    Article  PubMed  Google Scholar 

  22. Ramirez OM, Ramasastry SS, Granick MS, Pang D, Futrell JW (1987) A new surgical approach to closure of large lumbosacral meningomyelocele defects. Plast Reconstr Surg 80:799–809

    Article  CAS  PubMed  Google Scholar 

  23. Randolph LC, Barone J, Angelats J, Dado DV, Vandevender DK, Shoup M (2005) Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 116:1287–1290

    Article  CAS  PubMed  Google Scholar 

  24. Rios JL, Pollock T, Adams WP Jr (2003) Progressive tension sutures to prevent seroma formation after latissimus dorsi harvest. Plast Reconstr Surg 112:1779–1783

    Article  PubMed  Google Scholar 

  25. Seidel SB, Gardner PM, Howard PS (1996) Soft-tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 37:310–316

    Article  CAS  PubMed  Google Scholar 

  26. Shaer CM, Chescheir N, Schulkin J (2007) Myelomeningocele: a review of the epidemiology, genetics, risk factors for conception, prenatal diagnosis, and prognosis for affected individuals. Obstet Gynecol Surv 62:471–479

    Article  PubMed  Google Scholar 

  27. Sin AH, Rashidi M, Caldito G, Nanda A (2007) Surgical treatment of myelomeningocele: year 2000 hospitalization, outcome, and cost analysis in the US. Childs Nerv Syst 23:1125–1127

    Article  PubMed  Google Scholar 

  28. Talamonti G, D’Aliberti G, Collice M (2007) Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 107:368–386

    PubMed  Google Scholar 

  29. Teichgraeber JF, Riley WB, Parks DH (1989) Primary skin closure in large myelomeningoceles. Pediatr Neurosci 15:18–22

    Article  CAS  PubMed  Google Scholar 

  30. VanderKolk CA, Adson MH, Stevenson TR (1988) The reverse latissimus dorsi muscle flap for closure of meningomyelocele. Plast Reconstr Surg 81:454–456

    Article  CAS  PubMed  Google Scholar 

  31. Zakaria Y, Hasan EA (2009) Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 1:1–6

    Google Scholar 

  32. Zide BM, Epstein FJ, Wisoff J (1991) Optimal wound closure after tethered cord correction. Technical note. J Neurosurg 74:673–676

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

The authors would like to thank Holly Wagner for providing editorial assistance.

Disclaimer

The authors have no conflicts of interest to report pertaining to the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    Samuel C. Lien, Steven J. Kasten & Steven R. Buchman

  2. Department of Neurosurgery, University of Michigan Health System, 1500 E. Medical Center Drive, Room 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA

    Cormac O. Maher, Hugh J. L. Garton, Karin M. Muraszko & Steven R. Buchman

Authors
  1. Samuel C. Lien
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  2. Cormac O. Maher
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  3. Hugh J. L. Garton
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  4. Steven J. Kasten
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  5. Karin M. Muraszko
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  6. Steven R. Buchman
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Corresponding author

Correspondence to Cormac O. Maher.

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Lien, S.C., Maher, C.O., Garton, H.J.L. et al. Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst 26, 1091–1095 (2010). https://doi.org/10.1007/s00381-010-1099-9

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  • DOI: https://doi.org/10.1007/s00381-010-1099-9

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