V-Y plasty or primary repair closure of myelomeningocele: Our experience

Abstract

Background:Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Our study compares the outcomes of primary closure and V-Y plasty in the closure of Myelomeningocoeles.Methods:A prospective study of the infants who underwent surgical repair for MMC at our hospital from August 2014- January 2018 were included in the study. Total of 22 infants were treated, 9 underwent primary repair and 13 underwent V-Y plasty.Results:The time taken for primary closure was a mean of 120 min, while the advancement flap took longer of 190.7 min. All the 9 who underwent primary closure had CSF leak, 3 developed hydrocephalus, 6 had wound dehiscence, 3 had neurological deficits and 1 died. Of the 13 infants who underwent V-Y plasty 3 had CSF leaks, 1 had hydrocephalus, 5 had neurological deficits and no wound dehiscence or deaths.Conclusion:The aim of surgical repair is to cover the exposed neural tissue, prevent CSF leak and reduce CNS infections. V-Y plasty a plastic surgical technique of advancement flaps with intact pedicles improves the outcome of skin closure once the neural placode is placed in the dura and closed. This reduces the morbidity in a one-time procedure.

Factors affecting the intensive care stay of patients with spinal neural tube defects

“…This surgical treatment aims to close the exposed spinal cord and nerve roots without cerebrospinal fluid (CSF) leakage. Therefore, central nervous system infections due to CSF leakage are prevented (19).…”

“…According to case control studies and randomized clinical studies, if pregnant women do not take folic acid supplements or multivitamin supplements containing folic acid, they are 2-8 times more likely to be at risk (39). NTD affecting the lumbar spine is commonly seen in societies with a low socio-economic status (19). As the city where our hospital is located is found on the Syrian border, most of our cases are refugees residing in our country due to the Syrian civil war or those who were referred to our hospital because they could not obtain adequate healthcare despite living in their country.…”

“…In myelomeningocele (MMC), there is a defect in the junction of the lateral edges of the neural placode in the midline, and an opening is observed in the dorsal of the spinal cord due to this defect. It can occur anywhere in the spine, but is more common in the lumbosacral region (19).…”