Closure of Large Myelomeningocele by Lumbar Artery Perforator Flaps

Abstract

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.

The Lumbar Artery Perforator Flap

“…This flap can be used as a pedicled flap to reconstruct soft tissue defects in the lumbosacral region [2][3][4][5] including closure of myelomeningocele, a complex congenital malformations of the central nervous system, exposed spine, and other soft tissue defects in the back. 6,7 As a free flap, the LA perforator flap is a possible option for use in autologous breast reconstruction. 8 Although there have been a number of reports on the use of the LA perforator (LAP) flap for closure of lumbosacral defects and breast reconstruction, 8 there have been few anatomical studies to document the anatomy of the LA perforators.…”

Clinical Outcomes of Large Meningomyelocele Defect Repair by Bilateral Fasciocutaneous Rotation and Advancement Flaps with Perforators

“…9,10 There are many options for the reconstruction of large defects, such as skin grafting, local and regional fasciocutaneous flaps, musculocutaneous flaps, and perforator flaps. 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Skin grafting is a simple technique, but does not provide sufficient tissue to protect neural structures. Infections and ulcerations are also seen in the long-term follow up.…”

“…29 Dorsal intercostal and lumbar perforator flaps, which are based on the rich vascular network of the thoracal and lumbosacral area (supplied by perforator vessels), are used to reconstruct large defects of up to 9 cm x 10 cm. 26,27 The major problems with these flaps are the anatomical variation of their perforator location, as well as the anatomical variation of the vessels' calibration. Also, these perforator flaps are generally designed unilaterally, and this might result in unequal tension distribution at wound sites with the increase of defect size.…”

Modern techniques and alternative flaps in microsurgical breast reconstruction

“…The lumbar artery perforator (LAP) flap was first described in the literature by Kroll and Rosenfeld in 1988 as a new type of flap based on unnamed perforators arising near the midline of the lower back region. Since that time, additional studies have demonstrated the presence of perforators arising from four‐paired lumbar arteries, around which pedicled or free fasciocutaneous flaps can be designed . The first report of using the LAP flap in autologous breast reconstruction was described in 2003 by de Weerd, et al Since that time, Peters et al, and Seth and Greenspun have both reported on their early experience with the LAP flap for autologous breast reconstruction, outlining their technique and overall outcomes.…”