Soft-Tissue Repair of Myelomeningocele Defects Using Bilateral Latissimus Dorsi and Trapezius Musculocutaneous Flaps

The significance of the percentage of the defect size in spina bifida cystica in determination of the surgical technique

“…During muscle-skin flap preparation, nourishing vessels may be damaged at the time of the muscle releasing procedure and the function of the related muscle may then be violated [10]. Since muscles are released only from the paraspinal region, only segmental arteries can be damaged.…”

“…Skin flaps such as bipediculated flaps, local transposition flaps, and Limberg-type flaps involve a 20% risk of necrosis since they require excessive undermining [15,16,18]. Other methods that can be used in the closure of broad-based meningomyelocele defects are the use of muscle-skin island flaps or muscle-skin flaps [10,11,15,17,18]. In the muscle-skin flap technique, after detachment of the muscle, the muscle-skin complex is pulled to the midline with or without lateral releasing incisions.…”

“…Spina bifida aperta, the most frequently encountered congenital central nervous system abnormality, has an incidence of 1 per 800 births [10,12]. The meningocele and meningomyelocele defects found in 85% of spina bifida cases should be repaired soon after birth to decrease the risk of mortality and central nervous system infections, which are likely to hamper mental development [10,18].…”

“…The meningocele and meningomyelocele defects found in 85% of spina bifida cases should be repaired soon after birth to decrease the risk of mortality and central nervous system infections, which are likely to hamper mental development [10,18]. Mortality rates of 65-75% have been found in untreated patients in the first 6 months [8,9], and mortality rates of 30-40% in the 1st year and 50-60% in the first 3-5 years in treated patients [9].…”

Autologous amnion graft for repair of myelomeningocele: technical note and clinical implication

“…In such cases, techniques of local skin transfer such as wide undermining, skin advancement, and even bipedicular flap with/without lateral relaxing incision are not adequate for complete cover of exposed neural tissue, and results in wound breakdown, CSF leakage, and life-threatening infections. The reconstruction with several myocutaneous units [24][25][26] can offer more protection of the enclosed neural elements and good blood supply, but this technique leads to greater blood loss to the baby. The presented technique using amnion autograft will not cause additional blood loss, since the dissection of fascia or muscle to protect neural structure was not necessary.…”