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Reconstruction of Large Lumbar Myelomeningocele Defects: Improving Outcomes and Decreasing Morbidity Using Acellular Dermal Matrix
Anne Argenta, MD; Anand Kumar, MD; Zoe MacIsaac, BA; Shao Jiang, MD; Stephanie Greene, MD; Joseph E. Losee, MD; Lorelei Grunwaldt, MD
University of Pittsburgh Medical Center
2012-02-14
Presenter: Anne Argenta
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The above work represents the original work of the resident.
Director Name: Dr Joseph Losee
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
This presentation offers a new approach to myelomeningocele repair that improves the standard to care (autologous reconstruction), by preserving muscle that will be important for posture and gait as the patient grows. (objective 3)
How will your presentation be used by practicing physicians in the audience?
The presentation will expose the audience to a new, safe, effective alternative for myelomeningocele repair and a new use for acellular dermal matrix, with potential to change practice management.
Background: Large lumbar myelomeningocele are complex reconstructive challenges. In the current literature, there are many described approaches to repair, but limited objective and comparative data. Acellular dermal matrices are used successfully in many areas of reconstruction. These products offer potential alternatives to myocutaneous flaps for myelomeningocele repair, ideally minimizing donor site morbidity and improving long-term wound healing.
Aim: evaluate the safety/efficacy of acellular dermal matrix, specifically AlloDerm, in lumbar myelomeningocele repair
Methods: A retrospective case/control study of one institution's experience with myelomeningocele closure using autologous tissue closure (Group 1) or AlloDerm (Group 2) was performed between 2003-10. All cases were performed after neurosurgical closure of dural defect. Data collected included gender, gestational age, birth weight, defect size, operative details (flap type, AlloDerm use, layers of closure), complications (dehiscence, infection, CSF leak), need for reoperation, and length of follow-up.
Results: Fourteen patients were evaluated; six in Group 1 and eight in Group 2. The groups were comparable in demographics. In Group 1, 3/6 patients required two or more myocutaneous flaps for closure. The remainder required multiple complex skin flaps. In Group 2, 7/8 patients achieved closure with AlloDerm and fasciocutaneous flaps alone. No CSF leaks or infections occurred. One patient in Group 1 required reoperation for full dehiscence.
Conclusions: AlloDerm is a viable option for myelomeningocele repair. It is advantageous over autologous reconstruction, by preserving muscle important for posture and gait during growth. More information is needed regarding optimal thickness and number of AlloDerm layers to use in this context.
