Premiere use of Integra™ artificial skin to close an extensive fetal skin defect during open in utero repair of myelomeningocele

Meuli, Martin; Meuli‐Simmen, Claudia; Flake, Alan W.; Zimmermann, Roland; Ochsenbein, Nicole; Scheer, Ianina; Mazzone, Luca; Moehrlen, Ueli

doi:10.1007/s00383-013-3412-7

Cited by 24 publications

(27 citation statements)

References 21 publications

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“…The locations are not randomly distributed over the neural tube ( P = 2.0*10 −5 ) but show a preference for the occipital region, vertebrae C6 till T3 and the region between T8 and S1 with a peak at L5. (Richards et al, ; Tekkok, ; Etus et al, ; Singh and Singh, ; Srinivas et al, ; Ahmad and Mahapatra, ; Vashu and Liew, ; Bear et al, ; Carmody et al, ; Dankovcik et al, ; Singh and Singh, ; Singh et al, ; Vogel et al, ; Ahmed et al, ; Herman et al, ; Leykamm et al, ; Mahalik et al, ; Meuli et al, ; Sarici et al, ; van Aalst et al, ; Yang et al, ; De la Calle et al, ; Garg et al, ; Gressot et al, ; Hawasli et al, ; Leoni et al, ; Meadows and Hayes, ; Meunier et al, ; Perez da Rosa et al, ; Anand and Mahmoud, ; Canaz et al, ; Hanaei et al, ; Paul et al, ; Radtke et al, ; Ramdurg et al, ; Sargar et al, ; Wood et al, ; Arishima et al, ; Clark and Davidson, ; Dickman et al, ; Dorum et al, ; Santos et al, ; Sharma et al, ; Zhou and Zheng, ). [Color figure can be viewed at http://wileyonlinelibrary.com]…”

Section: Materials and Methods And Resultsmentioning

confidence: 99%

Single‐site neural tube closure in human embryos revisited

et al. 2017

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Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc.

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Section: Materials and Methods And Resultsmentioning

confidence: 99%

Single‐site neural tube closure in human embryos revisited

et al. 2017

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“…Another modification using Alloderm® or Duragen® patch for the dura was done in a subset of patients with large dural defects from the pre‐MOMS and MOMS cohorts, respectively, yet in an unknown number of patients and at the surgeon's discretion . Other clinically used techniques include the use of Alloderm® patch or Integra® dermal regeneration template as a skin patch for large skin defects . These materials have to our knowledge not been experimentally tested.…”

Section: Discussionmentioning

confidence: 99%

“…12,24,59 Other clinically used techniques include the use of Alloderm® patch or Integra® dermal regeneration template as a skin patch for large skin defects. 12,[60][61][62] These materials have to our knowledge not been experimentally tested.…”

Section: Analysis Of Outcome Datamentioning

confidence: 99%

Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review

et al. 2018

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The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2-layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.

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“…The entire maneuver takes about 5 min. Straightforward suturing as well as alternative ways to close the central skin defect, including lateral skin incisions [1,7,8] or implantation of skin substitutes (e.g., Alloderm TM [1,9], Epiflex ® (German Institute for Cell and Tissue Replacement GmbH, Berlin, Germany) (we used it twice, not published), or Integra Artificial Skin TM [10]), require similar amounts of time.…”

Section: Color Version Available Onlinementioning

confidence: 99%

In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair

et al. 2017

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Background: One of the intraoperative challenges of fetal spina bifida repair is skin closure when there is an extended skin defect. Thus, we examined whether distally pedicled random pattern transposition flaps (TFs) are a valid option to overcome this problem. Subjects and Methods: All patients undergoing in utero repair of spina bifida with application of a TF for back skin closure were analyzed focusing on intraoperative flap characteristics and postoperative flap performance. Results: In 30 (70%) of the 43 fetuses a primary skin closure was achieved, in 5 (12%) a skin substitute was used, and in 8 (18%) a TF was applied. Flap raising and insertion was uneventful and perfusion was sufficient in all 8 fetuses (100%). In 3 fetuses (37%) the donor sites were closed primarily, and in 5 (63%) a skin substitute was used for coverage. At birth, 7 flaps were viable and provided robust skin coverage over the center of the former lesion. Complications included a small skin defect with CSF leakage in 1 patient (13%). Conclusion: During open fetal spina bifida repair, TFs can be safely and efficaciously used to obtain solid and durable skin coverage over lesions too large to allow conventional primary skin closure.

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Premiere use of Integra™ artificial skin to close an extensive fetal skin defect during open in utero repair of myelomeningocele

Abstract: Integra™ appears to be a suitable coverage for large soft tissue defects in utero. Moreover, a postnatal reverse latissimus dorsi flap appears to markedly strengthen tissue coverage over a spinal cord rescued in utero.

Cited by 24 publications

References 21 publications

Single‐site neural tube closure in human embryos revisited

Single‐site neural tube closure in human embryos revisited

Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review

In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair

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