Meningomyelocele defect report: surgical technique selection

Year 2024, Volume: 6 Issue: 5, 331 - 334, 30.09.2024

Atakan Besnek

https://doi.org/10.38053/acmj.1543785

Abstract

Aims: Surgical repair of meningomyelocele is important in terms of infection, cerebrospinal fluid (CSF) leakage, and preservation of neural structures. While there are numerous techniques available for repair, there are few guidelines on when flap repair should be performed. In this study, we employed a method to select the surgical technique.
Methods: Thirty-two patients with meningomyelocele who underwent surgery were included in the study. The decision to use or not to use a flap was based on the ratio of defect height to width and the ratio of the axillary line to defect width.
Results: Fasciocutaneous transposition flap (FTF) repair was performed in 17 patients, whereas primary repair was performed in 15 patients. There was no statistically significant difference between the groups in terms of preoperative characteristics of the patients. In the FTF group, one patient experienced necrosis at the wound site, and one patient developed a cerebrospinal fluid fistula. In the primary repair group, necrosis was observed in one patient, CSF fistula developed in two patients, and central nervous system infection developed in one patient. No statistically significant difference was found between the groups in terms of complications.
Conclusion: The results obtained in the present study suggest that the shape of the defect and the ratio of intact tissue to defect size are more important than the size of the defect itself in achieving appropriate tension during repair. By employing the patient selection guidelines we achieved successful outcomes using a different flap technique.

Keywords

Meningomyelocele, Spinal Dysraphism, Postoperative Complications

Ethical Statement

The entire study was conducted in accordance with the Helsinki Declaration of 1975 (as revised in 2004 and 2008) This retrospective cohort study was approved by the ethics committee of Harran University (HRU/23.24.03, date of approval 25. 12. 2023). Since this was a retrospective study, consent was not obtained from the patients or their relatives.

References

• Schroeder HK, Nunes JC, Madeira L, et al. Postsurgical infection after myelomeningocele repair: a multivariate analysis of 60 consecutive cases. Clin Neurol Neurosurg. 2012;114(7):981-985.
• Liptak GS, Dosa NP. Myelomeningocele. Pediatr Rev. 2010;31(11):443-450.
• Sarifakioglu N, Bingül F, Terzioglu A, et al. Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects. Br J Plast Surg. 2003;56(3):303-306.
• Blanco-Dávila F, Luce EA. Current considerations for myelomeningocele repair. J Craniofac Surg. 2000;11(5):500-508.
• Turhan Haktanir N, Eser O, Demir Y, et al. Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method. Turk Neurosurg. 2008;18(3):311-315.
• Atik B, Tan O, Kiymaz N, et al. Bilobed fasciocutaneous flap closure of large meningomyeloceles. Ann Plast Surg. 2006;56(5):562-564.
• Kemaloğlu CA, Özyazgan İ, Ünverdi Ö F. A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair. J Neurosurg Pediatr. 2016;18(2):187-191.
• Mutaf M, Bekerecioğlu M, Erkutlu I, et al. A new technique for closure of large meningomyelocele defects. Ann Plast Surg. 2007;59(5):538-543.
• Kankaya Y, Sungur N, Aslan Ö, et al. Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap. J Neurosurg Pediatr. 2015;15(5):467-474.
• Jabaiti S, Al-Zaben KR, Saleh Q, et al. Fasciocutaneous Flap Reconstruction after Repair of Meningomyelocele: Technique and Outcome. Pediatr Neurosurg. 2015;50(6):344-349.
• McCraw JB, Penix JO, Baker JW. Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast Reconstr Surg. 1978;62(2):197-206.
• Sura Anitha ME, J P Varnika, Subodh Kumar Arige, Baliram Chikte,B K Lakshmi. Our Experience with Different Skin Closure Techniques in Meningomyeloceles. Int J Sci Stud. 2020;8(6):63-70.
• Sharma MK, Kumar N, Jha MK, et al. Experience with various reconstructive techniques for meningomyelocele defect closure in India. JPRAS Open. 2019;21:75-85.
• Shim JH, Hwang NH, Yoon ES, et al. Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair. Arch Plast Surg. 2016;43(1):26-31.
• Rodrigues AB, Krebs VL, Matushita H, et al. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst. 2016;32(4):675-680.
• Attenello FJ, Tuchman A, Christian EA, et al. Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst. 2016;32(9):1675-1681.
• Kobraei EM, Ricci JA, Vasconez HC, et al. A comparison of techniques for myelomeningocele defect closure in the neonatal period. Childs Nerv Syst. 2014;30(9):1535-1541.
• Luce EA, Walsh J. Wound closure of the myelomeningocoele defect. Plast Reconstr Surg. 1985;75(3):389-393.
• Mangels KJ, Tulipan N, Bruner JP, et al. Use of bipedicular advancement flaps for intrauterine closure of myeloschisis. Pediatr Neurosurg. 2000;32(1):52-56.