The use of rotation flaps following excision of lumbar myelo-meningoceles an aid to the closure of large defects

Patterson, Tiffany; Till, Kenneth

doi:10.1002/bjs.18004620012

Cited by 47 publications

(33 citation statements)

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“…However, the remaining 25% of patients with large defects require a more complex procedure. 6,18,21 In the literature, flap reconstruc- tion is recommended for defects that are > 5 cm in diameter, but this is not suitable for all patients because of different weights and usable skin tissue on the back. We closed small defects not only with primary repair but also with flaps.…”

Section: Discussionmentioning

confidence: 99%

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Kemaloğlu¹,

Özyazgan²,

Ünverdi³

2016

PED

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OBJECTIVE The closure of the skin defect in myelomeningocele (MMC) repair is an essential step that determines the quality of the surgical result. The success of surgical results is related to the decision to use the most suitable techniques, namely flaps or primary closure. The aim of this study was to evaluate the effectiveness of a decision-making guide to determine whether to use primary repair or a flap for the closure of skin defects that occur in MMC. METHODS Fifty patients underwent surgery after neurosurgical repair and closure of the placode. A simple guide was generated according to the defect height/width and posterior axillary lines/defect width ratio. These 2 ratios were considered to determine which closure technique (with or without primary repair) should be used for the MMC defect reconstruction. RESULTS By using this decision-making guide, 20 of the defects were repaired with various flaps, and those of the remaining 30 patients were repaired with primary closure. In all patients, a successful tension-free 1-stage closure was obtained. Except for 4 patients who had flap reconstruction with partial flap necrosis or minimal flap tip necrosis, healing was uneventful without any complications. There were no additional wound complications during the mean follow-up of 6.8 years (range 5 months to 14 years). CONCLUSIONS Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of MMC defects. The guide suggested here might be effective in deciding which method is suitable for closure of MMC skin defects.

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Section: Discussionmentioning

confidence: 99%

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Kemaloğlu¹,

Özyazgan²,

Ünverdi³

2016

PED

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“…Há maior prevalência de casos em famílias que já tenham alguma criança previamente acometida. A frequência varia em diferentes grupos étnicos, predominando na raça branca e em indivíduos de classe social baixa [3][4][5] . O diagnóstico pré-natal foi facilitado pelos novos métodos de imagem, trazendo consigo a possibilidade de intervenção cirúrgica intraútero 3,4 .…”

Section: Introductionunclassified

“…A maioria das MMGC, após reparo neurocirúrgico, apresenta defeitos cutâneos pequenos e passíveis de síntese primária e sem tensão, com aproximação das bordas na linha média. Para os defeitos maiores que 5 cm, que dificilmente podem ser fechados por sutura primária, são necessários métodos complementares [4][5][6] . Patterson 5 , em uma revisão de 130 casos, observou que, em 25% dos casos, não era possível a sutura primária, sendo necessária a utilização de técnicas cirúrgicas auxiliares.…”

Section: Introductionunclassified

Retalho fasciocutâneo bipediculado para tratamento de meningomieloceles

Pires¹,

Mello²,

Perin³

et al. 2010

Rev. Bras. Cir. Plást. (Impr.)

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“…5,10,22,29,30 Thomas initially described successful results with the fasciocutaneous triangular advancement flap and protection of the latissimus dorsi. 29 Cruz and colleagues reported on their closure of medium to large defects by using random-pattern double-Z rhomboid flaps.…”

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confidence: 99%

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

Kankaya

Sungur

Aslan

et al. 2015

PED

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OBJECT Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50–0.66 and 0.16–0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

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The use of rotation flaps following excision of lumbar myelo-meningoceles an aid to the closure of large defects

Cited by 47 publications

References 0 publications

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Retalho fasciocutâneo bipediculado para tratamento de meningomieloceles

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

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