Limberg-Latissimus Dorsi Myocutaneous Flap for Closure of Myelomeningocele

Abstract

A method is presented in which two well-recognized plastic surgical flap techniques are coupled: the Limberg rhomboid transposition flap and the latissimus dorsi myocutaneous flap. The technique was used in 2 patients to provide ample, innervated, and well-vascularized skin cover over myelomeningocele defects.

Primary closure of open myelomeningocele

“…In this fashion, a sheet of muscle can then be flapped down over the entire defect and sewn in place with 2-0 vicryl. There are many reports of complex plastic surgical closures in the literature; 4,5,7,10 however, at our institution we have found that closures of even the largest defects ( Fig. 2) can be effectively performed by the neurosurgeon when using the above techniques.…”

The repair of myelomeningocele with tissue expanders

“…Various methods of skin closure following repair of large myelomeningocel have been utilized successfully, these include local skin flaps; lumbosacral rotation flap [6], Limberg flap [17,19], transposition flap [4,10], double Z rhomboid flaps [5], bilateral bipedicled flaps [9], musculocutaneous flap variations, latissimus dorsi advancement flaps without lateral incisions [13], reverse latissimus dorsi flap [23,24], distally based latissimus dorsi flap [22], latissimus dorsi bipedicled and relaxing incision with superficial gluteal fascia [16], compound latissimus-gluteus flaps without a relaxing incision [7,14,21], primary skin grafting on turnover muscle and delayed grafting have also been used [ 11 ]. Local skin flaps require extensive skin undermining and thus there is a greater risk of wound edge necrosis than with muscle flaps.…”

Lyophilized Cadaver Dura Mater for Primary Repair of Myelomeningoceles

“…They relied on a layer-by-layer closure of the dura and the junctional zone to prevent CSF leak. In addition, various skin flaps and myocutaneous flaps have also been designed to cover large defects [5,6,11].…”