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Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair

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Abstract

Purpose

Of the many suggested techniques, we used dorsal intercostal perforator artery flap (DIPAF) for the closure of myelomeningocele defects. This study compared the outcomes of primary closure and DIPAF in the closure of myelomeningoceles.

Methods

Data of 24 patients that underwent myelomeningocele surgery at a single institution between November 2015 and September 2019 were retrospectively reviewed.

Results

The primary closure group had 13 patients (54.17%) and the DIPAF group had 11 (45.83%). The mean age was 7.91 ± 13.27 days (1–60 days). Twelve patients were female and 12 were male. In 22 patients, the myelomeningocele sacs were in the lumbosacral region, while in 2, they were in the thoracolumbar region. The mean defect sizes were 14.20 ± 4.62 cm2 and 18.44 ± 3.49 cm2 in the primary closure and DIPAF groups, respectively. In each group, four patients had a kyphotic deformity. In the primary closure group, three patients had wound necrosis, two had wound dehiscence, and four had cerebrospinal fluid (CSF) leakage. In the DIPAF group, one patient had wound necrosis and one had CSF leakage. Significantly fewer complications related to the operation area were observed in the DIPAF group (p < 0.05). Increased defect size, kyphotic deformity, and presence of hydrocephalus were found to be risk factors for complications related to the operation area.

Conclusion

This surgical treatment protects neural tissue, prevent CSF leakage, and reduce central nervous system infection rates in myelomeningocele patients. Closure technique with the fasciocutaneous skin flap has more satisfying results than primary closure.

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References

  1. Wallingford JB (2005) Neural tube closure and neural tube defects: studies in animal models reveal known knowns and known unknowns. Am J Med Genet C Semin Med Genet 135C(1):59–68

    Article  PubMed  Google Scholar 

  2. Lobo GJ, Nayak M (2018) V-Y plasty or primary repair closure of myelomeningocele: our experience. J Pediatr Neurosci 13(4):398–403

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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(7):471–479

    Article  PubMed  Google Scholar 

  4. Lien SC, Maher CO, Garton HJL, 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

    Article  PubMed  Google Scholar 

  5. El-khatib HA (2004) Large thoracolumbar meningomyelocele defects: incidence and clinical experiences with different modalities of latissimus dorsi musculocutaneus flap. Br J Plast Surg 57(5):411–417

    Article  PubMed  Google Scholar 

  6. Peranteau WH, Adzick NS (2016) Prenatal surgery for myelomeningocele. Curr Opin Obstet Gynecol 28(2):111–118

    Article  PubMed  Google Scholar 

  7. Atik B, Tan O, Kiymaz N, Yilmaz N, Tekes L (2006) Bilobed fasciocutaneous flap closure of large meningomyeloceles. Ann Plast Surg 56(5):562–564

    Article  CAS  PubMed  Google Scholar 

  8. Isik D, Tekes L, Eseoglu M, Isik Y, Bilici S, Atik B (2011) Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg 67(2):159–163

    Article  CAS  PubMed  Google Scholar 

  9. 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(6):799–809

    Article  CAS  PubMed  Google Scholar 

  10. Lapid O, Rosenberg L, Cohen A (2001) Meningomyelocele reconstruction with bilobed flaps. Br J Plast Surg 54(7):570–572

    Article  CAS  PubMed  Google Scholar 

  11. 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(3):218–225

    Article  PubMed  Google Scholar 

  12. Sarifakioglu N, Bingul F, Terzioglu A, Ates L, Aslan G (2003) Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects. Br J Plast Surg 56(3):303–306

    Article  PubMed  Google Scholar 

  13. Cruz NI, Ariyan S, Duncan CC, Cuono CB (1983) Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note. J Neurosurg 59(4):714–717

    Article  CAS  PubMed  Google Scholar 

  14. 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(7):1864–1868

    Article  PubMed  Google Scholar 

  15. Atik B, Tan O, Mutaf M, Senel B, Yilmaz N, Kiymaz N (2008) Skin perforators of back region: anatomical study and clinical applications. Ann Plast Surg 60(1):70–75

    Article  CAS  PubMed  Google Scholar 

  16. De Brito Henriques JG, Filho GP, Gusmao SN, Henriques KSW, Miranda ME (2007) Intraoperative acute tissue expansion for the closure of large myelomeningoceles. J Neurosurg 107(2 Suppl):98–102

    PubMed  Google Scholar 

  17. Luce EA, Walsh J (1985) Wound closure of the myelomeningocele defect. Plast Reconstr Surg 75(3):389–393

    Article  CAS  PubMed  Google Scholar 

  18. Moore TS, Dreyer TM, Bevin AG (1984) Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast Reconstr Surg 73(2):288–292

    Article  CAS  PubMed  Google Scholar 

  19. 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(2):144–147

    Article  PubMed  Google Scholar 

  20. Ulusoy MG, Kocer U, Sungur N, Karaaslan O, Kankaya Y, Ozdemir R, Gumus M (2005) Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps. Ann Plast Surg 54(6):640–644

    Article  CAS  PubMed  Google Scholar 

  21. Kankaya Y, Sungur N, Aslan ÖÇ, Ozer K, Ulusoy MG, Karatay M, Oruç M, Gürsoy K, Karaaslan Ö, Koçer U (2015) Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap. J Neurosurg Pediatr 15(5):467–474

    Article  PubMed  Google Scholar 

  22. Shim JH, Hwang NH, Yoon ES, Dhong ES, Kim DW, Kim SD (2016) Closure of myelomeningocele defects using a Limberg flap or direct repair. Arch Plast Surg 43(1):26–31

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Erciyes University School of Medicine, Kayseri, Turkey

    Tugay Atalay

  2. Department of Neurosurgery, Cukurova University School of Medicine, Saricam District, Balcali Campus, 01000, Adana, Turkey

    Kadir Oktay

  3. Department of Radiology, Gaziantep Medical Park Hospital, Gaziantep, Turkey

    Ebru Guzel

  4. Department of Plastic and Reconstructive Surgery, Yuzuncu Yil University School of Medicine, Van, Turkey

    Lutfi Tekes

  5. Department of Urology, Bahcesehir University School of Medicine, İstanbul, Turkey

    Mehmet Solakhan

  6. Department of Pediatrics, Division of Neonatology, Bahcesehir University School of Medicine, İstanbul, Turkey

    Servet Ozkiraz

  7. Department of Neurosurgery, Meydan Hospital, Sanliurfa, Turkey

    Bahattin Celik

  8. Department of Neurosurgery, Bahcesehir University School of Medicine, İstanbul, Turkey

    Aslan Guzel

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  1. Tugay Atalay
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  2. Kadir Oktay
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  3. Ebru Guzel
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  4. Lutfi Tekes
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  6. Servet Ozkiraz
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  7. Bahattin Celik
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  8. Aslan Guzel
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Correspondence to Kadir Oktay.

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Atalay, T., Oktay, K., Guzel, E. et al. Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair. Childs Nerv Syst 37, 229–233 (2021). https://doi.org/10.1007/s00381-020-04796-z

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  • DOI: https://doi.org/10.1007/s00381-020-04796-z

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