Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Myelomeningocele (MMC) is the most complex congenital malformation of the CNS that is compatible with life. Different closure techniques are available for defect reconstruction, but wound healing and tension-free closure of the skin in the midline remain major considerations in large MMCs. In this study, the authors used bilateral proximally based latissimus dorsi (LD) skin island muscle pedicle flaps for closure of large thoracolumbar MMC defects.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Twenty infants with very large thoracolumbar MMCs were enrolled in the study. The mean of age of the patients was 4.1 ± 2.3 months. The width of the MMC was 6 ± 1.2 cm. At operation, 2 triangular V-Y flaps were designed on each side of the defect; the tip of the triangle was extended to the posterior axillary line. The LD flaps based on the thoracodorsal arteries were elevated bilaterally and advanced toward the midline with moderate tension and sutured together. Postoperatively, infants were positioned prone for 7 days and discharged on the 8th day after the operation. They were followed every 2 weeks for evaluation of wound healing.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The wounds healed without any major complication. There was no dehiscence in the postoperative period.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors recommended bilateral superiorly based LD skin flaps as an effective method for closure of large thoracolumbar MMC defects. Neural tube defects are among the most common of all human birth defects.</jats:p></jats:sec>

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

“…Unlike perforator flaps, random-pattern flaps necessitate extensive dissection, and usually two flaps are needed for reconstruction of myelomeningocele defects. Use of musculocutaneous flaps such as latissimus dorsi flaps (6) have been reported; however, the back muscles are important for ambulation and must be spared (10) because many patients with myelomeningocele are future candidates for being wheelchair users (2).…”

Thoracolumbar Myelomeningocele Bursting Primary Repair: Safe Multilayer Secondary Reconstruction Using a Latissimus Dorsi Muscle Flap

“…The chance of survival increases, if an early watertight duraplasty and a definitive coverage with a myocutaneous unit is performed [7].…”

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

“…It is generally repaired immediately after birth within 24 to 48 hours in order to eliminate the effects of environmental factors such as infection, desiccation and heat. [1][2][3][4][5][6] However, based on the "two-hit hypothesis (the first-hit: the interruption of the neurulation in early pregnancy, and the second-hit: the destructive effect caused by intrauterine environment in the remaining period)", some surgeons recommend intrauterine MMC repair before 26 weeks of ges-tation to remedy "second-hit"-induced damage. [1][2][3][7][8][9][10][11][12][13] In addition, MMC repairs in utero decrease ventriculoperitoneal shunt dependence, prevent the progression of spinal cord damage, and improve neurological functions.…”

“…[1][2][3][7][8][9][10][11][12][13] Following the repair of the neural parts of the spinal cord, superficial dorsal layer renovations are performed with myocutaneous and muscular flaps such as latissimus dorsi and gluteus maximus. [5,[7][8][9][10]14] Morphometric features of these muscles used in MMC repair have recently become an area of interest for anatomists to determine if there is a dimensional change in fetuses with MMC. [15] On the other hand, the tensor fasciae latae (TFL) flaps can be preferred in the treatment of MMC.…”