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Improving Outcomes and Reducing Morbidity in Congenital Myelomeningocele Defects: A Cohort Comparison Study Between Muscle Flaps Versus Adipofascial Flaps with Supplemental Dermal Regenerative Templa
Oluwaseun A. Adetayo, MD, Anne Argenta, MD; Zoe MacIsaac, BA; MD; Lorelei J. Grunwaldt, MD, Anand R. Kumar, MD
University of Pittsburgh
2013-03-07
Presenter: Oluwaseun A Adetayo
Affidavit:
This project represents the original work of the fellow and attendings listed. The involvement of the presenting fellow includes data analysis, and final preparation and editing of the material presented.
Director Name: Joseph E. Losee
Author Category: Fellow Plastic Surgery
Background: Muscle flap (MF) closure is an accepted technique for congenital lumbar myelomeningocele, but can diminish trunk and lower limb strength. Adipofascial (AF) flaps with supplemental dermal regenerative templates (RDM) have the potential to spare innervated core muscles for wheel chair posture and limited ambulation.
Methods: A retrospective cohort comparison study of myelomeningocele defects treated with MF (Group 1) or AF flap /RDM (Group 2) was performed over 84 months.
Results: Six patients underwent MF repair (Group 1) and six underwent AF/RDM flap repair (Group 2). Average age 37 weeks, weight 3.49 kg, and defect size 24 cm2 in Group 1 vs. average age 36.1 weeks, weight 2.89 kg, and defect size 26.9 cm2 in Group 2 (p< .623, p< .528, p< .755, respectively). In Group 1, 3/6 (50%) patients required multiple > 2 MF and 3/6 (50%) required additional complex skin flaps for closure. In Group 2, closure was achieved in 7/8 (88%) patients with local AF/supplement RDM alone without complex skin closure and 1/8 (12%) with complex skin closure. Reoperation rate was 1/6 (17%) in Group 1 and none in Group 2 for full dehiscence (p<1.0). No CSF leaks or surgical site infections occurred in either group.
Conclusions: MF trended toward higher reoperation rates (17% vs. 0%), higher superficial wound complications (50% vs. 33%) and higher complex skin flap closure rates (50% vs. 12%). By sparing needed core muscles, AF flaps with RDM may present an advantage over MF closure.
