Dimensional assessment of the tensor fascia lata muscle in fetal cadavers with meningomyelocele for flap surgery

Abstract

Objectives: The tensor fasciae latae (TFL) muscle may be preferred for the closure of superficial dorsal layers in patients with meningomyelocele (MMC). This study aimed to display the algebraic anatomy of TFL in fetal cadavers with MMC compared to that in normal fetuses.  

Methods: Seven formalin-fixed fetuses with MMC (4 males and 3 females) aged from 18 to 27 weeks of gestation were dissected. A digital caliper (for the length and width of TFL) and digital image analysis software (for the surface area of TFL) were used to perform morphometric measurements. The numerical values of this study were compared with the calculated data obtained from the regression formula of a previously published article, considering fetal cadavers at the same gestational week.  

Results: No statistically significant difference was observed between the quantitative values related to TFL sizes in terms of side and gender (p>0.05). Considering the calculated data obtained from the regression formulas, TFL dimensions in fetal cadavers with MMC did not statistically differ from normal fetuses without any malformations (p>0.05). TFL sizes including length, area, and width in some fetuses with MMC were smaller (3 fetal cadavers) or larger (1 fetal cadaver) than those of normal fetuses described previously.   

Conclusion: TFL sizes including length, width and surface area in fetal cadavers with MMC were found similar to normal fetuses, statistically. Taking into account the individual differences related to TFL dimensions, whether MMC influences lower extremity muscle morphology should be examined in future studies. This anatomical knowledge related to TFL in fetuses with MMC should be taken into account when designing flap size.  

Objectives: The tensor fasciae latae (TFL) muscle may be preferred for the closure of superficial dorsal layers in patients with meningomyelocele (MMC). This study aimed to display the algebraic anatomy of TFL in fetal cadavers with MMC compared to that in normal fetuses.  

Methods: Seven formalin-fixed fetuses with MMC (4 males and 3 females) aged from 18 to 27 weeks of gestation were dissected. A digital caliper (for the length and width of TFL) and digital image analysis software (for the surface area of TFL) were used to perform morphometric measurements. The numerical values of this study were compared with the calculated data obtained from the regression formula of a previously published article, considering fetal cadavers at the same gestational week.  

Results: No statistically significant difference was observed between the quantitative values related to TFL sizes in terms of side and gender (p>0.05). Considering the calculated data obtained from the regression formulas, TFL dimensions in fetal cadavers with MMC did not statistically differ from normal fetuses without any malformations (p>0.05). TFL sizes including length, area, and width in some fetuses with MMC were smaller (3 fetal cadavers) or larger (1 fetal cadaver) than those of normal fetuses described previously.   

Conclusion: TFL sizes including length, width and surface area in fetal cadavers with MMC were found similar to normal fetuses, statistically. Taking into account the individual differences related to TFL dimensions, whether MMC influences lower extremity muscle morphology should be examined in future studies. This anatomical knowledge related to TFL in fetuses with MMC should be taken into account when designing flap size.  

Keywords

• fetus,flap,meningomyelocele,regression,tensor facia latae

References

1. 1) Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL; MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011;364:993-1004.
2. 2) Danzer E, Gerdes M, Bebbington MW, Zarnow DM, Adzick NS, Johnson MP. Preschool neurodevelopmental outcome of children following fetal myelomeningocele closure. Am J Obstet Gynecol 2010;202:450-9.
3. 3) Meuli M, Moehrlen U. Fetal surgery for myelomeningocele is effective: a critical look at the whys. Pediatr Surg Int 2014;30:689-97.
4. 4) Sahni M, Ohri A. Meningomyelocele. In: StatPearls [Internet]. StatPearls Publishing, 2019.
5. 5) Hosseinpour M, Forghani S. Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps. J Neurosurg Pediatr 2009;3:331-3.
6. 6) Zakaria Y, Hasan EA. Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 2010;63:1513-8.
7. 7) Fichter MA, Dornseifer U, Henke J, Schneider KT, Kovacs L, Biemer E, Bruner J, Adzick NS, Harrison MR, Papadopulos NA. Fetal spina bifida repair-current trends and prospects of intrauterine neurosurgery. Fetal Diagn Ther 2008;23:271-86.
8. 8) Meuli M, Meuli-Simmen C, Flake AW, Zimmermann R, Ochsenbein N, Scheer I, Mazzone L, Moehrlen U. Premiere use of Integra artificial skin to close an extensive fetal skin defect during open in utero repair of myelomeningocele. Pediatr Surg Int 2013;29:1321–6.

9. 9) Meuli-Simmen C, Meuli M, Hutchins GM, Harrison MR, Buncke HJ, Sullivan KM, Adzick NS. Fetal reconstructive surgery: experimental use of the latissimus dorsi flap to correct myelomeningocele in utero. Plast Reconstr Surg 1995;96:1007-11.
10. 10) Meuli-Simmen C, Meuli M, Adzick NS, Harrison MR. Latissimus dorsi flap procedures to cover myelomeningocele in utero: a feasibility study in human fetuses. J Pediatr Surg 1997;32:1154-6.
11. 11) Tulipan N, Bruner JP, Hernanz-Schulman M, Lowe LH, Walsh WF, Nickolaus D, Oakes WJ. Effect of intrauterine myelomeningocele repair on central nervous system structure and function. Pediatr Neurosurg 1999;31:183-8.
12. 12) Hutchins GM, Meuli M, Meuli-Simmen C, Jordan MA, Heffez DS, Blakemore KJ. Acquired spinal cord injury in human fetuses with myelomeningocele. Pediatr Pathol Lab Med 1996;16:701-12.
13. 13) Meuli M, Meuli-Simmen C, Hutchins GM, Seller MJ, Harrison MR, Adzick NS. The spinal cord lesion in human fetuses with myelomeningocele: implications for fetal surgery. J Pediatr Surg 1997;32:448-52.
14. 14) Bagłaj M, Ladogórska J, Rysiakiewicz K. Closure of large myelomeningocoele with Ramirez technique. Childs Nerv Syst 2006;22:1625-9.
15. 15) Beger O, Beger B, Dinç U, et al. Morphometric Features of the Latissimus Dorsi Muscle in Fetal Cadavers With Meningomyelocele for Prenatal Surgery. J Craniofac Surg Epub 2019 Jul 31. doi: 10.1097/SCS.0000000000005783.
16. 16) Phillips DP, Lindseth RE. Ambulation after transfer of adductors, external oblique, and tensor fascia lata in myelomeningocele. J Pediatr Orthop 1992;12(6):712-7.
17. 17) Posma AN. The innervated tensor fasciae latae flap in patients with meningomyelocele. Ann Plast Surg 1988; 21:594-6.
18. 18) Beger O, Koç T, Beger B, Uzmansel D, Kurtoğlu Z. Morphometric properties of the tensor fascia lata muscle in human foetuses. Folia Morphol (Warsz) 2018;77:498-502.
19. 19) Cutts A. Shrinkage of muscle fibres during the fixation of cadaveric tissue. J Anat 1988;160:75-8.
20. 20) Beger B, Beger O, Koç T, Dinç U, Hamzaoğlu V, Kayan G, Uzmansel D, Olgunus ZK. Quantitative and Neurovascular Anatomy of the Growing Gracilis Muscle in the Human Fetuses. J Craniofac Surg 2018;29:686-90.
21. 21) Beger O, Dinç U, Beger B, Uzmansel D, Kurtoğlu Z. Morphometric properties of the levator scapulae, rhomboid major, and rhomboid minor in human fetuses. Surg Radiol Anat 2018;40:449-55.
22. 22) Beger O, Koç T, Beger B, Özalp H, Hamzaoğlu V, Vayisoğlu Y, Talas DÜ, Olgunus ZK. Multiple muscular abnormalities in a fetal cadaver with CHARGE syndrome. Surg Radiol Anat 2018;41:601-5.
23. 23) Beger O, Koç T, Beger B, Kayan G, Uzmansel D, Olgunus ZK. Quantitative assessment of the growth dynamics of the teres major in human fetuses. Surg Radiol Anat 2018;40:1349-56.
24. 24) Beger O, Beger B, Uzmansel D, Erdoğan S, Kurtoğlu Z. Morphometric properties of the latissimus dorsi muscle in human fetuses for flap surgery. Surg Radiol Anat 2018;40:881-9.
25. 25) Beger O, Erdoğan O, Çetin Z, Kara E, Vayisoğlu Y, Hamzaoğlu V, Özalp H, Dağtekin A, Bağdatoğlu C, Öztürk AH, Talas DÜ. Evaluation of the Foramen Magnum Area Calculated by Different Methods: A Radioanatomic Study. J Craniofac Surg 2019;30(7):e665-7.