Skip to main content

Advertisement

SpringerLink
Log in

Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

We have previously reported a small series on the closure of large myelomeningocele (MMC) defects with a keystone design perforator island flap (KDPIF) in a paediatric neurosurgical centre in Australia. We are now presenting an updated longer term follow-up of an expanded series demonstrating longer term durability of this vascularized flap for large myelomeningocele defects.

Methods

The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2016. Retrospective analysis of the neurosurgical database revealed an additional three patients who underwent KDPIF closure at the Monash Medical Centre for MMC repair at birth.

Results

Wound healing was satisfactory in all six cases. With delayed follow-up, there was no associated skin flap separation, skin flap dehiscence, skin flap necrosis, cerebro-spinal fluid leak, however two infections were encountered, both resolved with conservative management including antibiotics and simple washout.

Conclusion

In this expanded case series with increased longevity of follow-up, the keystone design perforator island flap remains a robust alternative for closure of large myelomeningocele defects.

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

Similar content being viewed by others

References

  1. Kaye AH (2005) Developmental abnormalities. Essential neurosurgery, 3rd edn. Blackwell, Melbourne, pp 158–169

  2. De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC, Rayco-Solon P (2015) Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 14(12):CD007950. https://doi.org/10.1002/14651858.CD007950.pub3

  3. Norem CT, Schoen EJ, Walton DL, Krieger RC, O’Keefe J, To TT, Ray GT (2005) Routine ultrasonography compared with maternal serum alpha-fetoprotein for neural tube defect screening. Obstet Gynecol 106(4):747–752. https://doi.org/10.1097/01.AOG.0000178780.63956.3b

    Article  PubMed  Google Scholar 

  4. Boulet SL, Yang Q, Mai C, Kirby RS, Collins JS, Robbins JM, Meyer R, Canfield MA, Mulinare J, National Birth Defects Prevention N (2008) Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol 82(7):527–532. https://doi.org/10.1002/bdra.20468

    Article  CAS  PubMed  Google Scholar 

  5. Jabaiti S, Al-Zaben KR, Saleh Q, Abou Alrob M, Al-Shudifat AR (2015) Fasciocutaneous flap reconstruction after repair of meningomyelocele: technique and outcome. Pediatr Neurosurg 50(6):344–349. https://doi.org/10.1159/000439283

    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. Eur J Pediatr Surg 25(02):189–194. https://doi.org/10.1055/s-0034-1368796

    PubMed  Google Scholar 

  7. Lanigan MW (1993) Surgical repair of myelomeningocele. Ann Plast Surg 31(6):514–521. https://doi.org/10.1097/00000637-199312000-00007

    Article  CAS  PubMed  Google Scholar 

  8. 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. Childs Nerv Syst 26(8):1091–1095. https://doi.org/10.1007/s00381-010-1099-9

    Article  PubMed  Google Scholar 

  9. Gutman MJ, Goldschlager T, Fahardieh RD, Ying D, Xenos C, Danks RA (2011) Keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 27(9):1459–1463. https://doi.org/10.1007/s00381-011-1448-3

    Article  PubMed  Google Scholar 

  10. Behan FC (2003) The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 73(3):112–120. https://doi.org/10.1046/j.1445-2197.2003.02638.x

    Article  PubMed  Google Scholar 

  11. Tolhurst DE, Haeseker B, Zeeman RJ (1983) The development of the fasciocutaneous flap and its clinical applications. Plast Reconstr Surg 71(5):597–606. https://doi.org/10.1097/00006534-198305000-00001

    Article  CAS  PubMed  Google Scholar 

  12. Attenello FJ, Tuchman A, Christian EA, Wen T, Chang KE, Nallapa S, Cen SY, Mack WJ, Krieger MD, McComb JG (2016) Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst 32(9):1675–1681. https://doi.org/10.1007/s00381-016-3165-4

    Article  PubMed  Google Scholar 

  13. Cherian J, Staggers KA, Pan IW, Lopresti M, Jea A, Lam S (2016) Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis. J Neurosurg Pediatr 18(4):416–422. https://doi.org/10.3171/2016.1.PEDS15674

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia

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

  2. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

    Hamsaveni K. M. Murday

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

    Rory Maher

  4. Department of Surgery, Monash University, Melbourne, Victoria, Australia

    Tony Goldschlager & R. Andrew Danks

Authors
  1. Christopher Donaldson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamsaveni K. M. Murday
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. Gutman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rory Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tony Goldschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris Xenos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Andrew Danks
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher Donaldson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donaldson, C., Murday, H.K.M., Gutman, M.J. et al. Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 34, 733–736 (2018). https://doi.org/10.1007/s00381-017-3697-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-017-3697-2

Keywords

Search

Navigation