Skip to main content

Advertisement

SpringerLink
Log in

The deepithelialized skin flap for closure of large myelomeningoceles: a common plastic surgery technique for a novel neurosurgery application

  • Technical Note
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The study aims to demonstrate proof of principle of a common plastic surgery technique of deepithelialization for repair of large myelomeningoceles (MMCs). Whereas repair typically consists of a watertight dural closure followed by a muscle or fasciocutaeneous layer, excess skin, however, need not be discarded and can be deepithelialized to augment or, in selective cases, replace the muscle repair.

Methods

The study was performed through a retrospective chart review of two patients.

Results

Step-by-step figures illustrate the technique. Two patients each born with large MMCs measuring 10 × 11 cm and 6 × 9 cm, respectively, were reviewed. Excess skin was deepithelialized to create an additional layer of vascularized tissue over the muscle repair. There were no post-operative complications at 3-month follow-up.

Conclusions

In large MMCs with excess skin, the use of a deepithelialized skin flap can potentially be an alternative or adjunct to a muscle flap to buttress the dural repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Centers for Disease C Prevention, (2009) Racial/ethnic differences in the birth prevalence of spina bifida—United States, 1995–2005. MMWR Morb Mortal Wkly Rep 57:1409–1413

    Google Scholar 

  2. Khoshnood B, Loane M, de Walle H, Arriola L, Addor MC, Barisic I, Beres J, Bianchi F, Dias C, Draper E, Garne E, Gatt M, Haeusler M, Klungsoyr K, Latos-Bielenska A, Lynch C, McDonnell B, Nelen V, Neville AJ, O’Mahony MT, Queisser-Luft A, Rankin J, Rissmann A, Ritvanen A, Rounding C, Sipek A, Tucker D, Verellen-Dumoulin C, Wellesley D, Dolk H (2015) Long term trends in prevalence of neural tube defects in Europe: population based study. BMJ 351:h5949. doi:10.1136/bmj.h5949

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ramasastry SS, Cohen M (1995) Soft tissue closure and plastic surgical aspects of large open myelomeningoceles. Neurosurg Clin N Am 6:279–291

    CAS  PubMed  Google Scholar 

  4. Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR (2010) Local and regional flap closure in myelomeningocele repair: a 15-year review. Child’s Nerv Syst 26:1091–1095. doi:10.1007/s00381-010-1099-9

    Article  Google Scholar 

  5. 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. doi:10.1007/s10143-004-0357-2

    Article  PubMed  Google Scholar 

  6. Kesan K, Kothari P, Gupta R, Gupta A, Karkera P, Ranjan R, Mutkhedkar K, Sandlas G (2015) Closure of large meningomyelocele wound defects with subcutaneous based pedicle flap with bilateral V-Y advancement: our experience and review of literature. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery [et al.] = Zeitschrift fur Kinderchirurgie 25:189–194. doi:10.1055/s-0034-1368796

  7. Shim JH, Hwang NH, Yoon ES, Dhong ES, Kim DW, Kim SD (2016) Closure of myelomeningocele defects using a Limberg flap or direct repair. Archives Plastic Surg 43:26–31. doi:10.5999/aps.2016.43.1.26

    Article  Google Scholar 

  8. Spear S (2007) Breast Reduction: Inverted-T Technique. In: Thorne C (ed) Grabb and Smith’s Plastic Surgery. 6th edn. Lippincott Williams & Wilkins, pp 593–603

  9. Schoenmakers MA, Gulmans VA, Gooskens RH, Helders PJ (2004) Spina bifida at the sacral level: more than minor gait disturbances. Clin Rehabil 18:178–185

    Article  CAS  PubMed  Google Scholar 

  10. Sirzai H, Dogu B, Demir S, Yilmaz F, Kuran B (2014) Assessment on self-care, mobility and social function of children with spina bifida in Turkey. Neural Regen Res 9:1234–1240. doi:10.4103/1673-5374.135332

    Article  PubMed  PubMed Central  Google Scholar 

  11. Quong WL, Bulstrode NW, Thompson DN (2015) The use of de-epithelialized skin flap in the surgical repair of terminal myelocystoceles. Child’s Nerv Syst 31:473–479. doi:10.1007/s00381-014-2598-x

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, 1 Children’s Way, Little Rock, AR, 72202, USA

    Michael S. Golinko, Kumar Patel & Aaron Smith

  2. Department of Neurosurgery, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, 1 Children’s Way, Little Rock, AR, 72202, USA

    Rong Cai & Eylem Ocal

Authors
  1. Michael S. Golinko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kumar Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eylem Ocal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael S. Golinko.

Ethics declarations

Conflict of interest

None of the authors report a conflict of interest- financial or otherwise.

Informed consent

Parents of both patients in this report signed an informed consent to publication of their children’s photographs.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Golinko, M.S., Patel, K., Cai, R. et al. The deepithelialized skin flap for closure of large myelomeningoceles: a common plastic surgery technique for a novel neurosurgery application. Childs Nerv Syst 32, 1503–1506 (2016). https://doi.org/10.1007/s00381-016-3133-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-016-3133-z

Keywords

Search

Navigation