An Application of Keystone Perforator Island Flap for Closure of Lumbosacral Myelomeningocele Defects

Abstract

Myelomeningocele, also known as spina bifida, is the commonest form of neural tube defect in which both meninges and spinal cord herniate through a large vertebral defect. It may be located at any spinal level; however; lumbosacral involvement is most common. After birth, the closure of spinal lesion is preferably undertaken in the first 48 hours to minimize the risk of injury and central nervous system infection. Relatively small skin defects overlying the dural repair may be directly closed. However, larger defects require reconstructive closure. Numerous methods of reconstruction have been described, such as split skin graft, local flaps or lumbosacral fasciocutaneous flaps, muscle flaps using latissimus dorsi, gluteal or paraspinous muscles, and perforator flaps namely superior gluteal artery perforators, and dorsal intercostal artery perforator flaps. At Monash Health, Victoria, we have used the keystone perforator island flaps to reconstruct lumbosacral myelomeningocele defects on 5 newborns between January 2008 and January 2014. This article evaluates the short-term and long-term outcomes of these patients who were followed up for 10 to 66 months.

Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap

“…More recently, in a case series of 5 patients, Park et al 5 demonstrated the use of keystone flaps in lumbosacral myelomeningocele repair and concluded that it is an effective, reliable, and durable reconstructive option.…”

The application of keystone flap combined with vacuum‐assisted closure in the repair of sacrococcygeal skin defect after tumor resection

“…The special anatomy and anatomic site of this region lead to wounds that are difficult to remedy. The keystone design perforator island flap (KDPIF) has the advantages of simple design, sufficient blood supply from the perforators, and similar color and texture to the surrounding tissue, and having been widely used in clinical practice since it was first introduced . Vacuum‐assisted closure (VAC) effectively reduces secondary necrosis and infection of the wound, induces regeneration of the peripheral tissue, increases the rate of flap survival, and promotes wound healing .…”

Modified keystone flap for extremity defects after Mohs surgery

“…In the lower extremities, it has been used to reconstruct post‐traumatic injuries, such as leg open fractures . It has also been used for repairing lumbosacral defects in newborns with myelomeningocele …”

“…9 It has also been used for repairing lumbosacral defects in newborns with myelomeningocele. 10 Khouri et al described its use for the repair of defects after excision of soft tissue tumors in the trunk and limbs. 11 Al-Busaidi et al also described its use in defects that remain after burns.…”