When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation of the skin is a risky venture.
Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary epithelialisation.
Four of the children had two tissue expanders inserted at the age of 8–12 months; two of them before delayed operation for the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3–7 days during six to eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections, leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal.
Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed primary operation thus eliminating the need for extensive musculo-cutaneous flaps.
Antonyshyn, O, Gruss, JS, McKinnon, SE, Zucker, R 1988Complications of soft tissue expansion.Br J Plast Surg41239250PubMedGoogle Scholar
Bauer, BS, Johnson, PE, Lovato, G 1986Application of soft tissue expansion in children.Pediatr Dermatol3281290PubMedGoogle Scholar
Elias, DL, Baird, WL, Zubowics, VN 1991Applications and complications of tissue expansion in pediatric patients.J Pediatr Surg261521CrossRefPubMedGoogle Scholar
Friedman, RM, Ingram, AE, Rohrich, RJ, Byrd, HS, Hodges, PL, Bu Hobar, PC 1996Risk factors for complications in pediatric tissue expansion.Plast Reconstr Surg9812421246PubMedGoogle Scholar
Frykberg, T, Olsen, L 1990Tissue expansion facilitates operation of large myelomeningoceles.Z Kinderchir45242244PubMedGoogle Scholar
Gibstein, LA, Abramson, DL, Bartlett, RA, Orgill, DP, Upton, J, Mulliken, JB 1997Tissue expansion in children: a retrospective study of complications.Ann Plast Surg38358364PubMedGoogle Scholar
Gullestad, HP, Bretteville, G, Lundar, T, Enger, E 1993Tissue expansion for treatment of myeolomeningocele. Case report.Scand J Plast Reconstr Surg Hand Surg27149151PubMedGoogle Scholar
Luce, EA, Walsh, J 1985Wound closure of the myeolomeningocele defect.Plastic Reconstr Surg75389393CrossRefGoogle Scholar
Mustoe, TA, Gifford, GH, Lach, E 1988Rapid tissue expansion in treatment of myeolomeningocele.Ann Plast Surg217073PubMedGoogle Scholar
Neumann, CG 1957The expansion of an area of skin by progressive distension of subcutaneous balloon.Plast Reconstr Surg19124130PubMedGoogle Scholar
Ozveren, MF, Erol, FS, Topsakal, C, Tiftikci, MT, Akdemir, I 2002The significance of percentage of the defect size in spina bifida cystica in determination of the surgical technique.Childs Nerv Syst18614620PubMedGoogle Scholar