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Keystone design perforator island flap for closure of myelomeningocele

Child's Nervous System volume 27, pages 1459–1463 (2011)Cite this article

Abstract

Object

We present a series of three infants who underwent keystone design perforator island flap (KDPIF) closure for myelomeningocele in a paediatric neurosurgical centre in Australia. This is the first recorded utilization of this flap for primary closure of myelomeningocele (MMC).

Methods

The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2010. Retrospective analysis of these cases revealed three patients who underwent KDPIF at Monash Medical Centre for MMC repair at birth.

Results

Wound healing was prompt and satisfactory in all three cases. No minor or major complications were noted. In particular, there was no associated skin flap separation, skin flap dehiscence, skin flap necrosis, infection, cerebrospinal fluid leak, or need for return to theatre for further intervention to the wound. This keystone design perforator island flap is based on random perforating musculo/fasciocutaneous perforators. In our experience, this robust flap provides better tissue bulk, more reliable vascularity and a wider geometrical versatility than traditional random 1:1 cutaneous flaps.

Conclusion

Whilst primary closure remains an option for myelomeningocele closure, primary repair of larger defects can lead to closure site tension, stretching of inelastic scar tissue and inadequate soft tissue cover. In this small series, we have demonstrated the use of keystone design perforator island flap closure as an alternative for larger and more complex lesions.

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Acknowledgement

This article is dedicated to the late Mr. Guy Dowling, who tragically passed away in 2010. Mr. Dowling was a pioneer in implementing the keystone technique in the setting of myelomeningocele. His energy and enthusiasm for implementing and teaching congenital hand surgery were truly inspirational. His patients and colleagues will fondly remember him.

Disclosure

There are no conflicts of interests associated with this publication.

Author information

Affiliations

  1. Department of Surgery, Monash Medical Centre, Clayton, VIC, Australia

    Matthew J. Gutman, Tony Goldschlager, Rostam D. Fahardieh, David Ying, Chris Xenos & R. Andrew Danks

  2. Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia

    Matthew J. Gutman, Tony Goldschlager, Chris Xenos & R. Andrew Danks

  3. Department of Plastic Surgery, Monash Medical Centre, Clayton, VIC, Australia

    Rostam D. Fahardieh & David Ying

  4. Department of Medicine, Monash University, Clayton, VIC, Australia

    Matthew J. Gutman & R. Andrew Danks

  5. Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, 3168, Australia

    Matthew J. Gutman

Authors
  1. Matthew J. Gutman
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  2. Tony Goldschlager
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  3. Rostam D. Fahardieh
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  4. David Ying
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  5. Chris Xenos
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  6. R. Andrew Danks
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Corresponding author

Correspondence to Matthew J. Gutman.

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Funding and previous presentations

There was no external funding or support used in the creation of this article. No portion of the contents of this paper have previously been presented or published.

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Gutman, M.J., Goldschlager, T., Fahardieh, R.D. et al. Keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 27, 1459–1463 (2011). https://doi.org/10.1007/s00381-011-1448-3

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  • DOI: https://doi.org/10.1007/s00381-011-1448-3

Keywords

  • Keystone flap
  • Myelomeningocele
  • Dural leak
  • Keystone design perforator island flap
  • Spina bifida