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. 2024 Sep 29;14(5):2056-2070.
doi: 10.3390/clinpract14050162.

A Single-Centre Analysis of Surgical Techniques for Myelomeningocele Closure: Methods, Outcomes, and Complications

Alina Roxana Cehan  1 , Dorin Constantin Dorobanțu  1   2 , Corina Ionela Tamas  3   4 , Vlad Dimitrie Cehan  5 , Flaviu Tamas  3   4 , Adrian Balasa  3   4
Affiliations

A Single-Centre Analysis of Surgical Techniques for Myelomeningocele Closure: Methods, Outcomes, and Complications

Alina Roxana Cehan et al. Clin Pract. .

Abstract

(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement flap (VYF); and Limberg flap (LF). (2) Methods: A retrospective observational study was conducted from March 2015 to February 2023, and the inclusion criteria were newborns who underwent lumbosacral MMC within 24 h of birth. (3) Results: Out of 20 cases, 45% underwent DS closure; 25% underwent VY-F closure; 15% underwent LF closure, and 15% (n = 3) underwent combined flap closure. A significant statistical correlation was observed between intracranial hypertension (IH), the need for external ventricular drainage (EVD), and DS closure type. In the DS group, 60% of patients required EVD (p = 0.041), and 90% had IH (p = 0.027). CSF fistula was present in 40% of LF cases and 30% of DS cases, while wound dehiscence was observed in 60% of LF cases and 30% of DS cases. (4) Conclusions: Our study demonstrated that DS was linked to higher rates of complications. The VY-F is the safest method for closing MMC defects.

Keywords: Limberg flap; VY flap; direct suture; dysraphism; myelomeningocele.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Surgical steps for MMC closure (a–i).
Figure 2
Figure 2
The Limberg flap. The capital letters represent the sides of the rhomboid flap schematically depicted to aid in its explanation. The first black arrow indicates the transition from the rhomboid excision of the myelomeningocele to the graphic transposition of the remaining defect. The second black arrow represents the scheme of the flap transposition, while the last arrow shows the final appearance of this flap. The green line represents the spatial graphic exposure of the flap that is to be raised and transposed into the area of the created rhomboid defect. The green line formed by D’ E’ F’ is the graphic equivalent of DEF. The yellow diamond-shaped area represents the rhomboid defect created after the excision of the myelomeningocele.
Figure 3
Figure 3
The VY flap: bilateral (a,b) and unilateral (c,d).
Figure 4
Figure 4
Flow diagram for excluded patients.
Figure 5
Figure 5
Type of closure used. DS, direct suture; VY-F, VY advancement flap; LF, Limberg flap.
Figure 6
Figure 6
Frequency of complications with the wound closure technology. VP, ventriculoperitoneal; EVD, external ventricular drainage; CSF, cerebrospinal fluid; DS, direct suture; VY-F, VY advancement flap; LF, Limberg flap.
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