Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

Abstract

Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap.Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps.Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects.Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

A New Dissection Ladder Approach for Perforator Vessels in Infant Meningomyelocele Soft Tissue Reconstruction

“…We found that our surgical practice regarding the surgical line closure was matched with other studies 17–19 . Other study that recommends placing the midline skin scare on the repaired dura depended on the fascial turnover flap with or without the muscle.…”

“…We found that our surgical practice regarding the surgical line closure was matched with other studies. [17][18][19] Other study that recommends placing the midline skin scare on the repaired dura depended on the fascial turnover flap with or without the muscle. This technique allows no skin flap elevation, only skin undermining, so there will be no other placing for skin closure anywhere away from the midline.…”

Meningomyelocele Reconstruction: Comparison of Repair Methods via Systematic Review

“…40 Some studies have noted that the main limitation of primary closure is the actual size of the defect, but it is often the amount of surrounding redundant tissue that dictates plastic surgery consultation. 5,30 However, the average defect size closed primarily in the upper back was more than twice as large as the average defect closed primarily in the lumbar and lumbroscaral levels. Moreover, the redundant tissue of the upper back also likely contributed to the success of numerous other closure options, including random pattern and advancement flaps.…”

“…This was expected as MMCs most commonly affect the lumbrosacral levels of the posterior trunk, and the upper posterior trunk has much greater tissue laxity to facilitate primary closure by neurosurgeons 40 . Some studies have noted that the main limitation of primary closure is the actual size of the defect, but it is often the amount of surrounding redundant tissue that dictates plastic surgery consultation 5,30 . However, the average defect size closed primarily in the upper back was more than twice as large as the average defect closed primarily in the lumbar and lumbroscaral levels.…”

“…1). 3,5,6,8,[12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] In addition, a retrospective chart review of all MMC closures performed at Phoenix Children's Hospital from January 2015 to January 2020. After proper IRB approval, all closures performed by board-certified plastic surgeons were identified and further analyzed.…”