Myelomeningocele is the most complex congenital malformation of the central nervous system that is compatible with life. Different closure techniques are available for defect reconstruction, but wound healing and tension-free closure of the skin in the midline remain major considerations in large myelomeningoceles. In this study, bilateral lumbar artery perforator flaps were used for closure of large myelomeningocele defects. Fifteen infants and neonates with large myelomeningocele defects were enrolled in the study. The lumbar artery perforator flaps were elevated bilaterally or unilaterally and advanced toward the midline without tension and were sutured together. Most of the flaps healed without any major complication. The lumbar artery perforator flaps as is an effective method for closure of large myelomeningocele defects.
Aim Intracranial haemorrhage (ICH) in infancy is a rare life‐threatening event. The aim of this review is to highlight the association of ICH and potentially preventable vitamin K deficiency and to describe risk factors, presentation and outcome. Methods Original published data on ICH related to vitamin K deficiency during 2008–2012 were extracted from records of participating centres in Egypt (Cairo and Delta region). Full data on 70 infants (0–24 weeks) have been reported in three publications. Results The first study involved premature infants where ICH was potentially preventable with administration of parenteral vitamin K prophylactic doses to mothers ahead of imminent preterm delivery. The other 2 studies involved term newborns and infants. ICH due to early or classic vitamin K deficiency was reported in nine patients while 44 were due to late vitamin K deficiency. Main risk factors for late onset were exclusive breastfeeding, persistent diarrhoea and/or prolonged antibiotic therapy. Conclusion Vitamin K deficiency bleeding is a relatively frequent problem underlying ICH in infancy. Prophylactic vitamin K to mothers when anticipating preterm labour or a vitamin K boost in exclusively breast‐fed infants with prolonged antibiotic usage and, or, persistent diarrhoea might have an impact on prevention and outcome.
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