OMENTUM AND REVERSE TURNOVER LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP FOR THE TREATMENT OF CEREBROSPINAL FLUID FISTULA

Yıl 2015, Cilt: 49 Sayı: 5, 568 - , 24.09.2015

Yetkin Soyuncu , Omer Ozkan Zekiye Bigat İlkay Soyuncu

Öz

Conventional procedures can usually prevent cerebrospinal fluid ( CSF ) leakages, but they may not work for complicated cases.
In this case presentation we demonstrated     the effectiveness of combined omental and latissimus dorsi musculocutaneous flaps     for management of difficult CSF fistula. A reverse turnover latissimus dorsi musculocutaneous flap and omental flap were transferred for reconstruction of the     back wound and CSF leakage. The omental flap component was used to CSF     absorption and the latissimus dorsi muscle component was used to obliterate the dead space, to cover the exposed bone and for tension-free closure of the wound. The wound healed dramatically. We haven't seen severe donor site morbidity. The patienthas been followed for 30 months with no evidence of CSF leakage and no pseudomeningocele formation which was confirmed by magnetic resonance imaging (MRI) .
Although this is a case presentation, we can say that the combination of the omental and musculocutaneous flaps allow effective treatment and prevention of CSF fistulas in selected high-risk patients and provide durable coverage of complex spinal wounds.

 

Anahtar Kelimeler

Flap;omental transposition;reverse latissimus musculocutaneous flap;cerebrospinal fluid fistula;spine.

Kaynakça

• Riew KD, Khanna N. Treatment of cerebrospinal fluid leaks. In: Vaccaro AR, Betz RR, Zeidman SM, editors. Principles and practice of spine surgery. Philadelphia,USA: Mosby; 2003. p. 735–43.
• Pomeranz S, Constantini S, Umansky F. The use of fibrin sealant in cerebrospinal fluid leakage. Neurochirurgia (Stuttg) 1991;34:166–9.
• Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 2009;18:1169–74.
• Hochberg J, Ardenghy M, Yuen J, Gonzalez-Cruz R, Mi- ura Y, Conrado RM, et al. Muscle and musculocutaneous flap coverage of exposed spinal fusion devices. Plast Re- constr Surg 1998;102:385–92.
• de Fontaine S, Gaede F, Berthe JV. The reverse turnover latissimus dorsi flap for closure of midline lumbar defects. J Plast Reconstr Aesthet Surg 2008;61:917–24.
• Meiners T, Flieger R, Jungclaus M. Use of the reverse la- tissimus muscle flap for closure of complex back wounds in patients with spinal cord injury. Spine (Phila Pa 1976) 2003;28:1893–8.
• Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD. Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine (Phila Pa 1976) 2003;28:1203–11.
• Abuzayed B, Kafadar AM, Oğuzoğlu SA, Canbaz B, Kaynar MY. Duraplasty using autologous fascia lata re- enforced by on-site pedicled muscle flap: technical note. J Craniofac Surg 2009;20:435–8.
• Saint-Cyr M, Nikolis A, Moumdjian R, Frenette G, Cia- burro H, Harris PG, et al. Paraspinous muscle flaps for the treatment and prevention of cerebrospinal fluid fistulas in neurosurgery. Spine (Phila Pa 1976) 2003;28:86–92.
• Chun JK, Lynch MJ, Poultsides GA. Distal trapezius musculocutaneous flap for upper thoracic back wounds associated with spinal instrumentation and radiation. Ann Plast Surg 2003;51:17–22.
• Vitaz TW, Oishi M, Welch WC, Gerszten PC, Disa JJ, Bilsky MH. Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological dis- ease. J Neurosurg 2004;100(1 Suppl Spine):46–51.
• Azizkhan RG, Roberson JB Jr, Powers SK. Successful use of a vascularized intercostal muscle flap to seal a persistent intrapleural cerebrospinal fluid leak in a child. J Pediatr Surg 1991;26:744–6.
• Weber SM, Kim J, Delashaw JB, Wax MK. Radial forearm free tissue transfer in the management of persistent cere- brospinal fluid leaks. Laryngoscope 2005;115:968–72.
• Chang N, Mathes SJ. Comparison of the effect of bacte- rial inoculation in musculocutaneous and random-pattern flaps. Plast Reconstr Surg 1982;70:1–10.
• Levander B, Zwetnow NN. Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog. Acta Neurochir (Wien) 1978;41:147–55.
• Levander B, Zwetnow NN. Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog. Acta Neurochir (Wien) 1978;41:147–55.
• Giordano PA, Griffet J, Argenson C. Pedicled greater omentum transferred to the spine in a case of postopera- tive infection. Plast Reconstr Surg 1994;93:1508–11.
• Barrow DL, Nahai F, Tindall GT. The use of greater omen- tum vascularized free flaps for neurosurgical disorders re- quiring reconstruction. J Neurosurg 1984;60:305,11.
• Liebermann-Meffert D. The greater omentum. Anatomy, embryology, and surgical applications. Surg Clin North Am 2000;80:275–93.
• Lantieri LA, Tantaoui B, Rimareix FA, Raulo YF, Ba- ruch JP. Lower back coverage with endoscopically har- vested pedicled greater omental flap. Plast Reconstr Surg 1999;103:960–3.
• Hentschel SJ, Rhines LD, Wong FC, Gokaslan ZL, Mc- Cutcheon IE. Subarachnoid-pleural fistula after resec- tion of thoracic tumors. J Neurosurg 2004;100(4 Suppl Spine):332–6.
• Heller JG, Kim HS, Carlson GW. Subarachnoid--pleural fistulae--management with a transdiaphragmatic pedicled greater omental flap: report of two cases. Spine (Phila Pa 1976) 2001;26:1809–13.
• O’Shaughnessy BA, Dumanian GA, Liu JC, Ganju A, Ondra SL. Pedicled omental flaps as an adjunct in the closure of complex spinal wounds. Spine (Phila Pa 1976) 2007;32:3074–80.