Use of Bipedicular Advancement Flaps for Intrauterine Closure of Myeloschisis

Mangels, Kyle J.; Tulipan, Noel; Bruner, Joseph P.; Nickolaus, Delia

doi:10.1159/000028898

Cited by 32 publications

(36 citation statements)

References 10 publications

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“…The average complication rates have been reported between 7.7% and 33%. 10,14,15,20 Our overall complication rate was only 8%. Compared with the literature, this is very low; these results verified the reliability of our guide.…”

Section: Discussionmentioning

confidence: 60%

“…3,12 There is experimental and clinical evidence that in utero repair of MMCs may preserve neurological function. 15 However, this option is available in only a few centers; closure of an MMC defect is usually performed during the first hours after birth.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,14,15 Among the most common are CSF leak, meningitis, seroma, hematoma, skin flap necrosis, wound infection, and dehiscence. The average complication rates have been reported between 7.7% and 33%.…”

Section: Discussionmentioning

confidence: 99%

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A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Kemaloğlu¹,

Özyazgan²,

Ünverdi³

2016

PED

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OBJECTIVE The closure of the skin defect in myelomeningocele (MMC) repair is an essential step that determines the quality of the surgical result. The success of surgical results is related to the decision to use the most suitable techniques, namely flaps or primary closure. The aim of this study was to evaluate the effectiveness of a decision-making guide to determine whether to use primary repair or a flap for the closure of skin defects that occur in MMC. METHODS Fifty patients underwent surgery after neurosurgical repair and closure of the placode. A simple guide was generated according to the defect height/width and posterior axillary lines/defect width ratio. These 2 ratios were considered to determine which closure technique (with or without primary repair) should be used for the MMC defect reconstruction. RESULTS By using this decision-making guide, 20 of the defects were repaired with various flaps, and those of the remaining 30 patients were repaired with primary closure. In all patients, a successful tension-free 1-stage closure was obtained. Except for 4 patients who had flap reconstruction with partial flap necrosis or minimal flap tip necrosis, healing was uneventful without any complications. There were no additional wound complications during the mean follow-up of 6.8 years (range 5 months to 14 years). CONCLUSIONS Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of MMC defects. The guide suggested here might be effective in deciding which method is suitable for closure of MMC skin defects.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Kemaloğlu¹,

Özyazgan²,

Ünverdi³

2016

PED

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“…The entire maneuver takes about 5 min. Straightforward suturing as well as alternative ways to close the central skin defect, including lateral skin incisions [1,7,8] or implantation of skin substitutes (e.g., Alloderm TM [1,9], Epiflex ® (German Institute for Cell and Tissue Replacement GmbH, Berlin, Germany) (we used it twice, not published), or Integra Artificial Skin TM [10]), require similar amounts of time.…”

Section: Color Version Available Onlinementioning

confidence: 99%

“…In the literature, there is only one article [8] dealing with the problem of in utero skin reconstruction, although it is a frequent and clinically relevant topic. The authors reported using bipedicular bilateral advancement flaps for MS repair.…”

Section: Color Version Available Onlinementioning

confidence: 99%

In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair

et al. 2017

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Background: One of the intraoperative challenges of fetal spina bifida repair is skin closure when there is an extended skin defect. Thus, we examined whether distally pedicled random pattern transposition flaps (TFs) are a valid option to overcome this problem. Subjects and Methods: All patients undergoing in utero repair of spina bifida with application of a TF for back skin closure were analyzed focusing on intraoperative flap characteristics and postoperative flap performance. Results: In 30 (70%) of the 43 fetuses a primary skin closure was achieved, in 5 (12%) a skin substitute was used, and in 8 (18%) a TF was applied. Flap raising and insertion was uneventful and perfusion was sufficient in all 8 fetuses (100%). In 3 fetuses (37%) the donor sites were closed primarily, and in 5 (63%) a skin substitute was used for coverage. At birth, 7 flaps were viable and provided robust skin coverage over the center of the former lesion. Complications included a small skin defect with CSF leakage in 1 patient (13%). Conclusion: During open fetal spina bifida repair, TFs can be safely and efficaciously used to obtain solid and durable skin coverage over lesions too large to allow conventional primary skin closure.

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Intrauterine Surgical Techniques

Bruner¹,

Wilson

Adzick

et al. 2006

Encyclopedia of Medical Devices and Instrumentation

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Intrauterine surgery of the fetus or fetal adnexae is spreading rapidly throughout the world. In a broad sense, intrauterine surgery includes any procedure in which a medical device is purposely placed within the uterine cavity. For most physicians, however, the concept of intrauterine surgery excludes such commonly performed procedures as amniocentesis and chorionic villous sampling. Rather, the term usually refers to techniques requiring specialized knowledge, experience, and most especially, instrumentation. Procedures most commonly mentioned in discourses on intrauterine surgery include those specifically developed for the treatment of such serious anatomic defects as congenital cystic adenomatoid malformation (CCAM), sacrococcygeal teratoma (SCT), lower urinary tract obstruction (LUTO), myelomeningocele, aortic or pulmonic stenosis, gastroschisis, iatrogenic amniorhexis, twin‐to‐twin transfusion syndrome (TTTS), and twins discordant for severe anomalies. As no one person in the world is an expert in every one of these procedures, the remainder of this chapter is divided into individual sections, each authored by someone widely recognized as a leader in the treatment of that particular anomaly.

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Use of Bipedicular Advancement Flaps for Intrauterine Closure of Myeloschisis

Cited by 32 publications

References 10 publications

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair

Intrauterine Surgical Techniques

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