Bilateral Modified V-Y Advancement Flaps for Closing Meningomyelocele Defects

Abstract

Various reports describe surgical techniques for closing a meningomyelocele defect. We have used a combination flap consisting of a vertical bipedicled flap and V-Y advancement flap and used this technique in the successful repair of 11 meningomyelocele defects. The vertical bipedicled flap enhances the blood supply to the V-Y advancement flap with no sacrifice of muscle tissue. This flap can easily be moved to the midline, and the donor area can be primarily sutured with no complications. Our method has several advantages compared with previously reported methods: 1) no skin grafts are needed; 2) no muscle tissue is killed; 3) it is simple and easy, leading to less blood loss and minimal operative time; and 4) it is safe and produces reliable results while eliminating wound dehiscence and skin necrosis.

Comparison of dorsal intercostal artery perforator propeller flaps and bilateral rotation flaps in reconstruction of myelomeningocele defects

“…Random-pattern flaps such as rotation-transposition fasciocutaneous flaps (16), bilobed flaps (10), and bilateral V-Y advancement flaps (8), have been the mainstays in the treatment of myelomeningocele defects. However, random-pattern flaps are bound to the flap donor site by their pedicle, which limit their mobility and result in tension over the suture lines.…”

Clinical Outcomes of Large Meningomyelocele Defect Repair by Bilateral Fasciocutaneous Rotation and Advancement Flaps with Perforators

“…9,10 There are many options for the reconstruction of large defects, such as skin grafting, local and regional fasciocutaneous flaps, musculocutaneous flaps, and perforator flaps. 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Skin grafting is a simple technique, but does not provide sufficient tissue to protect neural structures. Infections and ulcerations are also seen in the long-term follow up.…”

Neurosurgical management of spina bifida: Research issues

“…Occasionally, the defect is large requiring rotational, musculocutaneous flaps, acute tissue expansion, and/ or skin grafting [Hadi et al, 1987;Ozveren et al, 2002;Muneuchi et al, 2005;Ulusoy et al, 2005;Arnell, 2006;Komuro et al, 2006;De Brito et al, 2007;Mutaf et al, 2007;Cole et al, 2008;Gumus, 2008]. Rarely, a newborn will have a severe spinal deformity requiring a kyphectomy simultaneously with placode closure [Reigel and McLone, 1988;Crawford et al, 2003].…”