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Singh S, Mane S, Jain S, Bajaj A. Clinical presentation and outcomes of neonates born with neural tube defects- an experience from a level III B NICU in Western India. Childs Nerv Syst 2024; 40:163-170. [PMID: 37452861 DOI: 10.1007/s00381-023-06078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Neural tube defects (NTDs) are one of the most common congenital anomalies and a cause of chronic disability. The study was done to study outcomes of neural tube defects admitted at a tertiary level neonatal intensive care unit (NICU) from 2018 to 2022, a period of 4 years that also coincided with the COVID pandemic. The secondary outcome was to study the clinical presentation, associated anomalies and epidemiological features. METHODS It was a retrospective observational study; data of infants was obtained from medical records and analysis was done. RESULTS Thirty-four neonates were enrolled, of which there were 16 (47%) males and 18 (53%) females. History of pre-pregnancy maternal folate intake was present in 4 (11.7%) cases. 33 (97%) babies were diagnosed with meningomyelocele (MMC) and one each had anencephaly, iniencephaly and encephalocele, of which one had frontal and two had occipital encephalocele. The median age of surgery was 16 days of life with primary repair being the most common procedure followed by MMC repair with VP shunt. Twenty babies (58.8%) were discharged successfully, while 9 (26.5%) expired and 5 (14.7%) were discharged against medical advice; which can be attributed to the financial problems of the patients in a developing country. The overall deaths in our series were four (26.5%) which is slightly higher than other studies which may be due to the fact that this study was conducted during the COVID era with lesser rates of folate supplementation, reduced access to prenatal diagnosis coupled with poor follow-up and compliance of patients post-surgical repair. CONCLUSION This study emphasizes the importance of periconceptional folic acid supplementation, prenatal diagnosis, early surgery and meticulous follow-up as being pivotal to improving outcomes in children with NTDs.
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Affiliation(s)
- Srijan Singh
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
| | - Sushant Mane
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Suhani Jain
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Aditi Bajaj
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Hifny MA, Park TH, Yagi S, Abdelmegeed AG, El-Shazly M. Myelomeningocele Defects Reconstruction With Various Types of keystone Flaps: An Algorithmic Approach Based on Defect Shape. J Craniofac Surg 2023:00001665-990000000-01128. [PMID: 37830806 DOI: 10.1097/scs.0000000000009779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023] Open
Abstract
The keystone flap has become an established option that has been utilized recently to close significant myelomeningocele defects. Although the keystone flaps can be adapted to repair myelomeningocele defects of different sizes, the shape of the defect is also an essential factor to consider. In this study, the authors proposed an algorithmic approach for reconstructing significant meningomyelocele defects utilizing different types of keystone flaps based on the shape of the resulting defect. From September 2016 to March 2022, the authors retrospectively reviewed the medical records of 28 patients with meningomyelocele who underwent repair with the keystone flaps. The mean age was 28 days (3 days to 4.5 months). Twenty-one meningomyelocele defects were in the lumbosacral (75%) and 7 in the thoracolumbar regions (25%). The defect sizes ranged from 3.5×5 cm (area, 13.4 cm2) to 9×7 cm (area, 49.5 cm2), with an average of 26.2 cm2. Ten meningomyelocele defects were a vertically oriented oval shape, 16 defects were a transversely oriented oval shape, and 2 defects were circular. In addition, unilateral keystone flap was used in 7.1% of the patients (2 patients), bilateral keystone flap in 28.6% (8 patients), and rotation advancement keystone flaps in 64.3% (18 patients). According to these findings, an algorithm was created based on the defect shape. This algorithmic approach is used as a decision-making guide to select the correct type of keystone flaps to repair myelomeningocele according to the defect shape.
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Affiliation(s)
- Mahmoud A Hifny
- Department of Plastic Surgery, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, Yonago, Japan
| | | | - Mohamed El-Shazly
- Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
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Closure of meningomyelocele defects using various types of keystone-design perforator island flaps. Arch Plast Surg 2021; 48:261-268. [PMID: 34024070 PMCID: PMC8143945 DOI: 10.5999/aps.2020.01326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/12/2021] [Indexed: 11/08/2022] Open
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.
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Gomar-Alba M, Vargas-López AJ, Narro-Donate JM, Castelló-Ruiz MJ, García-Pérez F, Masegosa-González J. Rotation flap closure of a giant dorsolumbar myelomeningocele: technical note. Childs Nerv Syst 2021; 37:1323-1326. [PMID: 33454814 DOI: 10.1007/s00381-020-05021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Myelomeningocele (MMC) is the most prevalent form of spina bifida aperta. Here we present the surgical repair technique of a dorsolumbar myelomeningocele with a large associated soft tissue defect. METHODS Data concerning the anamnesis and complementary studies were obtained from the clinical history. Surgical images were obtained in the operation room during surgery. RESULT We describe the case of a newborn with a dorsal myelomeningocele with a placode in the central area and a large associated skin defect of 12 x× 12 cm. Urgent intervention was carried out on the day of birth with placode reconstruction. Dorsal and gluteus maximus muscle rotation and skin rotation flap were performed in order to achieve complete closure of the myocutaneous defect. The patient presented a good recovery with no new neurological deficit. CONCLUSION Myelomeningocele may be associated with large myocutaneous defects that can be difficult to correct by primary closure. In these cases, rotation flaps may be necessary to achieve complete closure.
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Affiliation(s)
- Mario Gomar-Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain.
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Brown OH, Makar KG, Ulma RM, Buchman SR, Kasten SJ, Muraszko KM, Vercler CJ. A Simplified Approach to Myelomeningocele Defect Repair. Ann Plast Surg 2021; 86:58-61. [PMID: 32349084 DOI: 10.1097/sap.0000000000002374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Repair of the soft tissue defect in myelomeningoceles remains challenging. The literature currently lacks a systematic approach, reporting high rates of complications. We present outcomes from the largest series to date and describe a simplified approach that minimizes morbidity and streamlines decision making. METHODS Patients 1 year or younger who underwent myelomeningocele repair between 2008 and 2018 were reviewed. Flap types were categorized by tissue composition. Complications were dichotomized into early and late (<30 days and >30 days postoperative, respectively). Logistic regression was used to measure the impact of flap tissue composition and skin closure technique on odds of postoperative complications. RESULTS Ninety-seven patients met inclusion criteria. Reoperation was required in only 3 (3.0%) patients-1 for wound dehiscence and 2 for surgical site infections. Zero cases of tethered cord or cerebrospinal fluid leak occurred. The most common minor complications were early wound complications (n = 18, 18.6%) and early infection (n = 5, 5.2%). Fascia-only flaps and muscle + other tissue flaps were not associated with higher odds of complications compared with muscle-only flaps (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.53-8.50, P = 0.29; OR = 2.87, 95% CI 0.66-12.51, P = 0.16, respectively). Rhomboid flaps for skin closure were associated with higher odds of complications (OR, 4.47; 95% CI, 1.00-19.97; P = 0.05). CONCLUSIONS Our approach to myelomeningocele repair demonstrated no cases of secondary tethered cord or cerebrospinal fluid leak, and reoperative rates were extremely low. Because complications were unrelated to flap type, we recommend a simplified approach using any tissue type for dural coverage and 2-layer primary closure of the skin.
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Jowdy PK, Perry RJ, Reynolds RM. Use of an abdominal reapproximation anchor system in the closure of large, open myelomeningoceles. J Neurosurg Pediatr 2020; 25:402-406. [PMID: 31978887 DOI: 10.3171/2019.11.peds19225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
Open neural tube defects are complex congenital abnormalities of the nervous system in which nervous tissue is exposed on the patient's back at the time of delivery. These malformations require surgical correction, and although replacement of the neural placode internally is fairly standard, providing skin closure can be very challenging especially in large defects. An abdominal reapproximation anchor (ABRA) device may be of value in attaining skin closure in these large, open myelomeningocele defects in which primary closure cannot be accomplished surgically. In a study period during which 65 patients underwent surgical closure of open myelomeningocele defects, 5 of them underwent ABRA-assisted closure.The average surgical intervention for myelomeningocele repair occurred on day 2.2 of life (range 2-3 days). The average defect size was 37 cm2 (range 16-56 cm2), and the average time to formal closure was 30.8 days (range 8-63 days). One of the patients had natural closure with just ABRA approximation. The remaining 4 patients underwent formal delayed primary closure when the skin edges became approximated. Use of the ABRA system in the closure of a large, open myelomeningocele may be valuable in select patients but requires further follow-up and comparison to identify truly significant differences with traditional techniques.
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Affiliation(s)
- Patrick K Jowdy
- 1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and
| | - Robert J Perry
- 2Division of Plastic Surgery, University at Buffalo, New York
| | - Renee M Reynolds
- 1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and
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Rehman L, Shiekh M, Afzal A, Rizvi R. Risk factors, presentation and outcome of meningomyelocele repair. Pak J Med Sci 2020; 36:422-425. [PMID: 32292446 PMCID: PMC7150388 DOI: 10.12669/pjms.36.3.1237] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: To determine the risk factors, presentation and outcome of meningomyelocele repair Methods: We reviewed 150 cases operated for meningomyelocele (MMC) at Jinnah Postgraduate Medical Centre Karachi between May 2015 and May 2018. Data of infants operated for MMC repair was extracted including socioeconomic status, maternal folate intake during pregnancy, head circumference, location and width of the defect, accompanying bladder and limb anomalies and treatments administered. Patients were followed up for a mean period of six months. Results: A total of 150 children were evaluated, out of which there were 83(55.3%) males and 67(44.7%) females. All belonged to low socio economic group and prenatal maternal folate intake as risk factor was positive in 103(68.7%) cases. Mean head circumference was 37.4 cm (range, 30.7 to 50 cm). Based on their location, 83(55%) of the defects were lumbosacral, 38(25.4%) were lumbar, 16(10.7%) were thoraco lumbar, 10(6.7%) were thoracic and three (2%) were cervical. Mean size of the meningomyelocele sac was 4.3 cm×5.6 cm (range, 1cm×2 cm to 11cm×8.4cm) and 21(14%) of the babies had a skin defect requiring flap. According to accompanying anomalies, 98(65.3%) of the babies had hydrocephalus, 13(9%) had club foot, four (2.7%) had diastematomyelia and three (2%) had tethered cord. Eighty seven (58%) patients had neurological deficit pre operatively and eight (5.4%) patients with normal power deteriorated after surgery out of which five (3.3%) developed paraplegia and three (2%) developed paraparesis. CSF leak was the major complication encountered in 16(11%) followed by meningitis in seven (5%), while the overall mortality was four (2.6%). Conclusion: The practice of periconceptional folic acid supplementation is essential to reduce the prevalence of neural tube defects (NTDs) in the developing world. Improved maternal nutrition with access to quality antenatal care is vital to decrease the prevalence and health burden.
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Affiliation(s)
- Lal Rehman
- Dr. Lal Rehman, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Munwar Shiekh
- Dr. Munwar Sheikh, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Ali Afzal
- Dr. Ali Afzal, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Raza Rizvi
- Dr. Raza Rizvi, MS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Chen YN, Yang SH, Chou SC, Kuo MF. The role of sacral laminoplasty in the management of spina bifida and sacral cystic lesions: case series. Neurosurg Focus 2019; 47:E20. [PMID: 31574475 DOI: 10.3171/2019.7.focus19414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although laminae are not viewed as essential structures for spinal integrity, in the sacrum the anatomical weakness and gravity makes it a vulnerable area for CSF accumulation and expansion. The congenital or postoperative defects of sacral laminae, such as in patients with spina bifida, make this area more susceptible to forming progressive dural ectasia, pseudomeningocele, or expansile arachnoid cyst (Tarlov cyst). In addition, adhesions between the dura and surrounding soft tissue after laminectomy can cause some local symptoms, which are difficult to relieve. The authors propose that sacral laminoplasty with titanium mesh can provide a rigid support and barrier to resolve these sacral lesions and local symptoms. METHODS From January 2016 to December 2017, patients with progressive CSF-containing lesions in the sacral area and defective sacral laminae were included in the study. After repair of the lesion, the authors performed sacral laminoplasty with titanium mesh in each patient. Subsequently, the soft tissue and skin were closed primarily. RESULTS A total of 6 patients were included. Four patients with repaired myelomeningocele had progressive dural ectasia. One patient with lipomyelomeningocele previously underwent detethering surgery and developed postoperative pseudomeningocele. One patient had a symptomatic Tarlov cyst. Four of these 6 cases presented with low-back pain and local tenderness. During follow-up, ranging from 13 to 37 months, all 6 patients experienced no recurrence of dural ectasia or pseudomeningocele and were free from local symptoms. CONCLUSIONS Sacral laminoplasty with titanium mesh is a safe and effective procedure for treating progressive sacral dural ectasia and refractory pseudomeningocele, preventing CSF leakage as well as relieving local symptoms that may occur years after previous surgery for spina bifida.
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Affiliation(s)
- Yu-Ning Chen
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
| | - Shih-Hung Yang
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
| | - Sheng-Che Chou
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.,2Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, National Taiwan University College of Medicine, Yunlin; and.,3Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Meng-Fai Kuo
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
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Bhatnagar V, Kulkarni SN, Muzammil MD. Anesthetic challenges in leaking meningomyelocele repair in a neonate. JOURNAL OF MARINE MEDICAL SOCIETY 2019. [DOI: 10.4103/jmms.jmms_71_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alimi Y, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. Intelligence Quotient in Patients with Myelomeningocele: A Review. Cureus 2018; 10:e3137. [PMID: 30345194 PMCID: PMC6188215 DOI: 10.7759/cureus.3137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It has been proposed that hydrocephalus in children with myelomeningocele (MMC) can indicate a low intelligence quotient (IQ). Others have argued that it is not the mere presence of hydrocephalus but the superimposition of cerebrospinal fluid (CSF) infections, multiple shunt procedures, and other CNS complications that lead to the lowering of IQ in these patients. In this paper, we review the literature to clarify the information about IQ in patients with MMC and whether it changes after infections and shunt procedures. We have also considered the other factors that could be involved in the IQ development of these patients and the differences revealed by the brain imaging of individuals with MMC. The consensus remains that patients with MMC, with or without complications, tend to have a lower IQ than those without MMC. Hydrocephalus appears to decrease the IQ further in MMC patients. Some have proposed that prenatal repair of the MMC lesion reduces the need for ventricular shunting after birth, thus decreasing the risk of shunt complications such as a CNS infection, which can have a negative effect on IQ. More studies are needed to assess other risk factors (apart from folate deficiency) and genetic factors that could contribute to the development of MMC and their possible effects on patient IQ.
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Affiliation(s)
- Yusuf Alimi
- Anatomy, St. George's University School of Medicine, St. George's, GRD
| | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, USA
| | - Rod J Oskouian
- Neurosurgery, Swedish Neuroscience Institute, Seattle, USA
| | - Marios Loukas
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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Bevan R, Wilson-Jones N, Bhatti I, Patel C, Leach P. How much do plastic surgeons add to the closure of myelomeningoceles? Childs Nerv Syst 2018; 34:737-740. [PMID: 29222684 PMCID: PMC5856885 DOI: 10.1007/s00381-017-3674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE This study reviews the outcomes of children undergoing myelomeningocele (MMC) repair in the paediatric neurosurgical department in Cardiff. These procedures are historically performed by paediatric neurosurgeons with occasional support from plastic surgeons for the larger lesions. We reviewed the postoperative outcomes over a 9-year period to assess the efficacy of having a plastic surgeon present at all MMC closures. METHODS Analysis of a prospectively collected database of all MMC closures performed at University Hospital Wales from April 2009 to August 2017 was used. Comparison was made with the published literature especially with regard to complications. RESULTS Thirty-one children, 13 males and 18 females, underwent MMC closure over the 9-year period. Twenty-four (77.4%) defects were closed by direct approximation. Seven patients (22.5%) required a more complex plastic procedure to obtain closure. Two patients (6.5%) had a wound complication, one wound infection and one flap edge necrosis both healing with dressings alone. Two patients had cerebrospinal fluid (CSF) leaks that responded to ventriculo-peritoneal shunting. Two patients died from unrelated conditions during the study period. CONCLUSION In our series, 7/31 (22.5%) cases involved a more complex closure in keeping with the literature. The authors feel that having the plastic surgeon at all closures has led to a low wound complication rate.
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Affiliation(s)
- Rhian Bevan
- University Hospital of Wales College of Medicine, Cardiff, UK.
| | | | - Imran Bhatti
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Chirag Patel
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Paul Leach
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
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North WD, Khoury L, Christopher Spears R, Liau JY, Pittman T. Use of dermal regeneration template to close a giant myelomeningocele in a newborn. J Neurosurg Pediatr 2016; 18:635-637. [PMID: 27503247 DOI: 10.3171/2016.6.peds16127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many techniques are available to close a myelomeningocele, but large lesions can be particularly difficult to close given the absence of surrounding tissue. The authors present the case of a 2-day-old girl with a large lumbosacral myelomeningocele who underwent a staged repair using dermal regeneration template (DRT; Integra) followed by split-thickness skin grafting. The results demonstrated that the combined use of myofascial turnover flaps and DRT with delayed skin grafting is a safe, effective option for this challenging reconstructive dilemma.
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Affiliation(s)
| | - Laith Khoury
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - R Christopher Spears
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - James Y Liau
- Division of Plastic and Reconstructive Surgery; and
| | - Thomas Pittman
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Kemaloğlu CA, Özyazgan İ, Ünverdi ÖF. A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair. J Neurosurg Pediatr 2016; 18:187-91. [PMID: 27104629 DOI: 10.3171/2016.2.peds15702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Cemal Alper Kemaloğlu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, Kayseri, Turkey
| | - İrfan Özyazgan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, Kayseri, Turkey
| | - Ömer Faruk Ünverdi
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, Kayseri, Turkey
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