Summary
Background
Closure of the skin defect in myelomeningocele repair is an essential step that determines
the quality of the surgical result. In large myelomeningoceles, however, adequate
skin coverage may not be accomplished by direct closure or skin undermining. In such
cases, the skin defect is best repaired using flaps. The aim of this study is to evaluate
the reading man procedure for closure of large meningomyelocele defect.
Methods
In this procedure, after neurosurgical repair and closure of the placode, the defect
surgically becomes a circle in shape. Then, the circular defect is closed by transposition
of two skin flaps designed in an unequal Z-plasty manner. Over 5 years, the reading
man procedure was used for closure of large meningomyelocele defects in seven patients
(four females and three males), aged between 1.5 and 6 months. The defect size was
10.5×7.25 cm (8.5×5.3 and 12.6×9.5 cm) on average. The localisation of the lesions was thoracolumbar in two patients
and lumbosacral in five patients.
Results
In all patients, a successful tension-free one-stage closure was obtained without
dog-ear formation. Except for one patient with minimal tip necrosis, healing was uneventful
without any complications. There was no patient with late breakdown of the wound during
1.5 years (8 months–4 years) of mean follow-up.
Conclusions
The reading man procedure enables the surgeon to achieve a tension-free defect closure
of considerably large meningomyeleocele defects. Using two well-vascularised fasciocutaneous
flaps, it provides a durable coverage and soft tissue padding over the neural tissues
with no suture seam at midline. With these advantages, the Reading Man Procedure seems
to be a useful and safe alternative for closure of large meningomyelocele defects.
Keywords
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Article info
Publication history
Published online: November 15, 2011
Accepted:
October 6,
2011
Received:
August 8,
2011
Footnotes
☆This study was presented at the XXXIIth Annual Congress of Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, in Trabzon, Turkey, 15–19 September 2010.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
