The goals of this study were to review the outcome of the surgical procedure and hospitalization associated with meningomyelocele repair, and to examine the results of different closure strategies.
Eighty-three consecutive patients having surgery for meningomyelocele over a ten year period form the basis of this study. Thirty-two closures with a mean defect size preoperatively of 11.5 cm2 were performed by the neurosurgeon (ADP), and fifty-one closures with a mean defect size of 28.4 cm2 by the plastic surgeon (MFA).
Defects up to 12 cm2 were closed with local advancement fasciocutaneous flaps. As defect size increased, latissimus muscle flaps were added in 30 (36%) and gluteus muscle in 16 (19%). In recent years, 18 patients (21.6%) with a mean defect of 29 cm2 were treated with overlapping of deepithelialized fasciocutaneous flaps to add an additional layer of coverage to the dural closure.
There were 9 major complications, 6 requiring reoperation. There were 10 minor wound failures managed conservatively. Mean hospital stay was 24.2 days. Re-operation increased length of stay to 45 days (p < 0.0001). Minor wound problems added 6 days to mean hospital stay. Wound failure did not correlate with either defect size or closure technique. Thoracic location was associated with increased wound failure (p < 0.05). Use of a shunt did not increase morbidity. All closures remained durable after discharge.
Location in the thoracic area predicts major wound failure and need for reoperation. Wound complications significantly increase hospital stay. The use of a variety of techniques to achieve multi-layered closures leads to durable coverage for defects of all sizes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects.JAMA. 1989; 262: 2847
- Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus.JAMA. 1999; 282: 1819
- Fetal reconstructive surgery: experimental use of the latissimus dorsi flap to correct myelomeningocele in utero.Plast Reconstr Surg. 1995; 96: 1007
- Use of bipedicular advancement flaps for intrauterine closure of myeloschisis.Pediatr Neurosurg. 2000; 32: 52
- Decision making in primary surgical repair of myelomeningoceles.Ann Plast Surg. 1995; 35: 272
- Split-thickness skin grafting of the myelomeningocele defect: a subset at risk for late ulceration.Plast Reconstr Surg. 1991; 87: 116
- Simultaneous repair of myelomeningocele and shunt insertion.Childs Nerv Syst. 2004; 20: 107
- Experience with simultaneous ventriculo-peritoneal shunt placement and myelomeningocele repair.J Pediatr Surg. 1988; 23: 913
- Comparison of simultaneous versus delayed ventriculoperitoneal shunt insertion in children undergoing myelomeningocele repair.J Child Neurol. 1996; 11: 370
- Spina Bifida.in: McCarthy Plastic surgery. WB Saunders, Philadelphia1990: 3780-3796
- Early closure of myelomeningocele, with special reference to leg movement.Br Med J. 1967; 1: 666
- Closure of a large myelomeningocele. Case report.Plast Reconstr Surg. 1973; 51: 464
- Meningomyelocele reconstruction with bilobed flaps.Br J Plast Surg. 2001; 54: 570
- In utero repair of myelomeningocele: experimental pathophysiology, initial clinical experience, and outcomes.Arch Surg. 2003; 138: 872
- Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note.J Neurosurg. 1983; 59: 714
- Tension free closure of large meningomyelocele defects.Surg Neurol. 1977; 8: 177
- Wound closure of the myelomeningocoele defect.Plast Reconstr Surg. 1985; 75: 389
- Closure of meningomyelocele defects with bilateral modified v-y advancement flaps.Ann Plast Surg. 2005; 54: 640
- Repair of large myelomeningoceles.Arch Surg. 1969; 98: 41
- A method of repair of myelomeningoceles.Br J Surg. 1972; 59: 445
- Concepts in the management of spina bifida.in: Humphreys R.P. Concepts in Pediatric neurosurgery. vol. 5. Karger, Basel1965: 97-106
- The use of rotation flaps following excision of lumbar myelomeningocoeles: an aid to the closure of large defects.Br J Surg. 1959; 46: 606
- Spina Bifida.in: NcKayrub R.L. Scgyt K. Veines J.L. Pediatric neurosurgery. 2nd ed. WB Saunders Company, Philadelphia1989
- Modified limberg flap for lumbosacral meningomyelocele defects.Ann Plast Surg. 1979; 3: 114
- Anatomic studies and clinical experience with fasciocutaneous flap closure of large myelomeningoceles.Plast Reconstr Surg. 1996; 97: 1400
- Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap.Plast Reconstr Surg. 1978; 62: 197
- Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps.Ann Plast Surg. 1987; 18: 147
- A new surgical approach to closure of large lumbosacral meningomyelocele defects.Plast Reconstr Surg. 1987; 80: 799
- Followup on the bilateral lastissimus dorsi gluteus maximus myocutaneous flap closure of meningomyelocoele defects.Plast Surg Forum. 1993; 16: 59
- Soft tissue closure and plastic surgical aspects of large open myelomeningoceles.Neurosurg Clin N Am. 1995; 6: 279
- Limberg-latissimus dorsi myocutaneous flap for closure of myelomeningocele.Childs Brain. 1983; 10: 381
- Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps.Plast Reconstr Surg. 1984; 73: 288
- Meningomyelocele closure with distally based latissimus dorsi flap.Plast Reconstr Surg. 1984; 73: 956
- The reverse latissimus dorsi muscle flap for closure of meningomyelocele.Plast Reconstr Surg. 1988; 81: 454
- Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.Br J Plast Surg. 2003; 56: 303
- Closure of thoracic and lumbar dysgraphic defects using bilateral latissimus dorsi myocutaneous flap transfer with extended gluteal fasciocutaneous flaps.Childs Brain. 1982; 9: 394
- Bilateral latissimus dorsi V-Y musculocutaneous flap for closure of a large meningomyelocele.Plast Reconstr Surg. 1991; 88: 520
- Surgical repair of large meningomyeloceles.Ann Plast Surg. 1984; 12: 501
- Closure of large meningomyelocele defects by composite skin-muscle flaps.Plast Reconstr Surg. 1971; 47: 234
- Modified bilateral advancement flap: the slide-in flap.Ann Plast Surg. 1999; 42: 545
- A new approach to closure of large lumbosacral myelomeningoceles: the superior gluteal artery perforator flap.Plast Reconstr Surg. 1864; 114: 2004
- The use of pedicled perforator flaps for reconstruction of lumbosacral defects.Ann Plast Surg. 2000; 45: 7
- Use of lumbar periosteal turnover flaps in myelomeningocele closure.Neurosurgery. 1996; 39: 522
Published online: February 10, 2012
Accepted: October 6, 2011
Received: July 25, 2011
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.