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Review
. 2010 Aug;26(8):1091-5.
doi: 10.1007/s00381-010-1099-9. Epub 2010 Mar 2.

Local and regional flap closure in myelomeningocele repair: a 15-year review

Affiliations
Review

Local and regional flap closure in myelomeningocele repair: a 15-year review

Samuel C Lien et al. Childs Nerv Syst. 2010 Aug.

Abstract

Purpose: A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size.

Methods: We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect.

Results: Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis.

Conclusions: Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair.

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