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Repair of Large Myelomeningocele Defect with Local Fasciocutaneous Flaps
Kylie A. Fuller, MD candidate
Cristiane M. Ueno, MD, FACS
West Virginia University School of Medicine
2018-02-02
Presenter: Kylie A Fuller
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 submitting and presenting author of the work for this project has predominately been accomplished through their efforts. She conceived and developed the majority of the study design with the assistance of the faculty, acquired most, analyzed all, and interpreted the data. She was also responsible for the majority of drafting the abstract text with the assistance and guidance from the more senior authors on the abstract.
Director Name: Aaron Mason, MD, FACS, FAAP
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Myelomeningocele (MMC) is a congenital neural tube defect leads to herniation of the meninges and spine. Successful closure of MMCs is important due to the numerous complications (CSF leak, meningitis, seroma, hematoma, skin necrosis, wound infection, and dehiscence) that can result from inadequate closure. The majority of MMC defect closures are primary closures performed by neurosurgeon alone. In cases where primary closure is not possible, local flaps and combined procedures with plastic surgeons are required. Myocutaneous flaps (latissimus dorsi and gluteus maximus) are traditionally used by plastic surgeons for closure of extremely wide MMC defects, but local fasciocutaneous flaps (V-Y, bilobed, Double-Z rhomboid and Limberg) have also been described. This case series demonstrates two cases where closure with fasciocutaneous flaps was obtained via a combined procedure with plastic surgery (defects were 68 cm2 and 16 cm2), and one case where neurosurgery performed primary closure (defect was 28cm2). In the first two cases, the patients progressed well with no wound dehiscence or local infection. In the third case, an area of dehiscence and exposed dura developed. On post-op week 2, plastic surgery was consulted and obtained closure with relaxing incisions. This case series showed the utility of a multi-disciplinary approach to minimize complications. Additionally, it showed successful closure with fasciocutaneous flaps instead of the traditional myocutaneous flaps. Fasciocutaneous flaps are preferred since they spare the patient's musculature (reducing functional deficits), decrease tension, increase padding and decrease the risk of complications. Therefore, we recommend utilizing a multi-disciplinary approach to close large MMCs.
