Closure of Large Meningomyelocele Wound Defects with Subcutaneous Based Pedicle Flap with Bilateral V-Y Advancement: Our Experience and Review of Literature

Kesan, Krushnakumar; Kothari, Paras; Gupta, Rahul; Gupta, Abhaya; Karkera, Parag; Ranjan, Ritesh; Mutkhedkar, Kedar; Sandlas, Gursev

doi:10.1055/s-0034-1368796

Cited by 12 publications

(10 citation statements)

References 13 publications

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“… 10 Over the past years, variable reconstructive techniques for soft tissue coverage of MMC defect have been described. 11 – 13 Such techniques, based on understanding the anatomy of the vascular perforators and the concept of angiosomes, were utilized to avoid the high failure rate of traditional closure in the past with extensive undermining and closure under tension. 11 – 13 Therefore, flap reconstructive procedures are preferred to minimize the risk of high complications associated with primary closure in large defects.…”

Section: Discussionmentioning

confidence: 99%

“… 11 – 13 Such techniques, based on understanding the anatomy of the vascular perforators and the concept of angiosomes, were utilized to avoid the high failure rate of traditional closure in the past with extensive undermining and closure under tension. 11 – 13 Therefore, flap reconstructive procedures are preferred to minimize the risk of high complications associated with primary closure in large defects. Local flaps have been commonly described 14 , 15 ; however, one of the main issues that may arise is inadequate blood circulation associated with these random pattern flaps.…”

Section: Discussionmentioning

confidence: 99%

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Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients

Kattan

Al-Sufayan

Alammar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries. Methods: This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients’ clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study. Result: Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases. Conclusions: In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients

Kattan

Al-Sufayan

Alammar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…While locoregional flaps are the standard of care in most sacral wound defects, they are not plausible in many scenarios. Numerous local flap options have been reported, including gluteal artery perforator flaps (13–16), gluteus maximus sliding flaps (17), paraspinal flaps (18), V-Y advancement flaps (19, 20), and regional anterolateral thigh flaps (21). However, they are relatively contraindicated in oncological sacral defects.…”

Section: Discussionmentioning

confidence: 99%

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

García-Tutor¹,

Romeo²,

Chae³

et al. 2016

Front. Surg.

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BackgroundLocoregional flaps are sufficient in most sacral reconstructions. However, large sacral defects due to malignancy necessitate a different reconstructive approach, with local flaps compromised by radiation and regional flaps inadequate for broad surface areas or substantial volume obliteration. In this report, we present our experience using free muscle transfer for volumetric reconstruction, in such cases, and demonstrate three-dimensional (3D) haptic models of the sacral defect to aid preoperative planning.MethodsFive consecutive patients with irradiated sacral defects secondary to oncologic resections were included, surface area ranging from 143–600 cm2. Latissimus dorsi (LD)-based free flap sacral reconstruction was performed in each case, between 2005 and 2011. Where the superior gluteal artery was compromised, the subcostal artery (SA) was used as a recipient vessel. Microvascular technique, complications, and outcomes are reported. The use of volumetric analysis and 3D printing is also demonstrated, with imaging data converted to 3D images suitable for 3D printing with Osirix software (Pixmeo, Geneva, Switzerland). An office-based, desktop 3D printer was used to print 3D models of sacral defects, used to demonstrate surface area and contour and produce a volumetric print of the dead space needed for flap obliteration.ResultsThe clinical series of LD free flap reconstructions is presented, with successful transfer in all cases, and adequate soft-tissue cover and volume obliteration achieved. The original use of the SA as a recipient vessel was successfully achieved. All wounds healed uneventfully. 3D printing is also demonstrated as a useful tool for 3D evaluation of volume and dead space.ConclusionFree flaps offer unique benefits in sacral reconstruction where local tissue is compromised by irradiation and tumor recurrence, and dead space requires accurate volumetric reconstruction. We describe for the first time the use of the SA as a recipient in free flap sacral reconstruction. 3D printing of haptic bio-models is a rapidly evolving field with a substantial role in preoperative planning.

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“…To treat this, utmost priority is given to the prevention of central nervous system infection as well as protection of the exposed nerves and structures from additional trauma. As such, early closure is recommended and is ideally within 48 hours of birth to eliminate these risks [ 9 ]. Although most wounds are small enough to be closed mainly with simple soft tissue approximation, local flaps may be needed in about 25% of cases where the defects are deemed as large [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…As such, early closure is recommended and is ideally within 48 hours of birth to eliminate these risks [ 9 ]. Although most wounds are small enough to be closed mainly with simple soft tissue approximation, local flaps may be needed in about 25% of cases where the defects are deemed as large [ 9 ]. Transposition of local tissues with similar qualities is needed to achieve the closure of the skin defect following repair in an ideal manner.…”

Section: Introductionmentioning

confidence: 99%

Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects - A case report

Mrad

Alharbi

Mahabbat

et al. 2020

Annals of Medicine and Surgery

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Introduction Myelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, keystone island flap can be used for closure of large MMCs. Presentation of case A new-born girl born as a product of 36 weeks of gestation had a weight of 3.020 kg and had multiple congenital anomalies including hydrocephalus, thoracolumbar myelomeningocele at the level of (T10-L4) and an atrial septal defect. Preoperative evaluation showed a head circumference of 42 cm (n: mean 34.4 ± 2SD), no lower limbs movements and a thoracolumbar soft tissue defect around 4 × 8 cm with exposed neuronal tissue and prominent thoracic kyphosis, and no obvious urogenital or limbs anomalies. The large thoracolumbar myelomeningocele was treated at KFSHRC with a Keystone Design Perforator Island Flap (KDPIF) to reconstruct the soft tissue defect following the neurosurgical reconstruction. Discussion The keystone flaps were deemed as viable as all wounds were healed without any complications, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers a simple and effective method of wound closure in situations that would, otherwise, have required complex flap closure. Conclusion This flap can be an effective method for reconstruction of large thoracolumbar MMC defects that might improve outcome and minimize complications. It also ensures good watertight closure with minimal wound tension and breakdown.

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Closure of Large Meningomyelocele Wound Defects with Subcutaneous Based Pedicle Flap with Bilateral V-Y Advancement: Our Experience and Review of Literature

Cited by 12 publications

References 13 publications

Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients

Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects - A case report

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