Local Flaps with Negative Pressure Wound Therapy in Secondary Reconstruction of Myelomeningocele Wound Necrosis

The First Case of Fetus in Fetu in Nicaragua: The Management Experience of the Pediatric Neurosurgery Team

Fetus in fetu (FIF) is a rare congenital anomaly of asymmetric monozygotic twins, where the parasitic twin develops abnormally inside the body of the host twin. In most cases, it is incorporated into the sibling's abdomen, which frequently presents as a retroperitoneal mass. Currently, at least 200 cases have been reported worldwide, being this the first case in Nicaragua. We describe a case of a male newborn, born via cesarean section, with a history of multiple congenital malformations observed via ultrasound examination. At birth, a mass is observed on its dorsum that impresses a skull, but without the presence of bones, with three limbs, two upper and one lower, with an outline located transversely on the pelvic girdle and the presence of two male genitalia with agenesis of the testicles and an accessory kidney. A preoperative diagnosis of FIF and spinal dysraphism was made by computed tomography (CT) and magnetic resonance imaging (MRI). They shared a spinal cord and had the presence of an open spinal defect type meningocele with aberrant roots. After the diagnosis and discussion, the multidisciplinary team proceeded to surgery to perform the separation of the twin (FIF). The subsequent anatomopathological examination revealed that the fetus was anencephalic and had reliable FIF characteristics. The resection was performed followed by the closure of the 430 mL meningocele and complete separation of the spine and the parasitic twin. We present the first case of fetus in fetu in Nicaragua.

Negative pressure wound therapy in cases of spinal surgery and exposed dura: a case-based review

PURPOSE

Study of negative pressure wound therapy (NPWT) safety for patients with intraoperative exposure of the dura.

METHODS

We analyzed the literature on the NPWT usage after spinal surgery in patients with exposure of the dura. We also described our experience of NPWT in 3 pediatric patients with spinal dysraphism. Due to the peculiarities of the anatomy (spina bifida), all of these patients had dural sac exposure during spinal surgery.

RESULTS

The reasons for NPWT in all three cases were different. In the first patient with segmental spinal dysgenesis, surgery was complicated by extensive postoperative wound necrosis and the formation of soft tissue deficiency. The second patient with post-myelomeningocele kyphosis had a deficiency of soft tissues during spinal surgery due to a large bedsore at the apex of the deformity. And in the third patient also with post-myelomeningocele kyphosis, NPWT was applied with surgical site infection. In all three cases, NPWT was used when the dura was exposed, without complications and with satisfactory results. The observation period for the patients was 3 years, 2.5 years, and 2 years, respectively.

CONCLUSIONS

The usage of NPWT in cases of wound complications in the spinal surgery may be a useful option, which allows saving implants. NPWT is not contraindicated in cases of intraoperative dural exposure if there are no signs of cerebrospinal fluid (CSF) leak.

Clinical Experiences with Closed Incisional Negative Pressure Wound Treatment on Various Anatomic Locations

Background

Closed incisional negative pressure wound treatment (ciNPWT) is one of the promising methods for the prevention of complications in surgical incisions. The mechanisms of ciNPWT have previously been elucidated and in this series, we demonstrate various, as of yet, underreported uses for the technology. Our aim is to share our experience with ciNPWT on various anatomic sites with novel indications. 

Materials and methods

ciNPWT was used in 24 patients. The mean age was 49.6. All the incisions were sutured, clean, and non-infected. Patients’ sex, age, comorbidities, anatomic location of the wound, and the indications for ciNPWT were recorded.

Results

The mean number of applications was three per patient. One suture dehiscence after one session of ciNPWT was encountered in a flap donor site of an infant operated for meningomyelocele. Late-term seroma and hematoma formation were encountered in two patients. No surgical site infection, wound dehiscence, and ciNPWT related complications were seen in other patients. The majority of the applications were on the trunk, lower extremity, pelvis, upper extremity, and scalp respectively. Indications for ciNPWT utilization were preventing dehiscence, seroma, and hematoma formation in the majority of the patients.

Conclusion

ciNPWT is reliable and effective in the prevention of post-operative wound dehiscence and surgical site infections. It can be used safely in various locations and different indications for preventingcomplications such as preventing dehiscence in revision surgeries, cerebrospinal fluid (CSF) fistula formation in the scalp, and wound breakdown in chronic corticosteroid use,

Acellular Dermal Matrix as a Definitive Reconstructive Option for Management of a Large Myelomeningocele Defect in the Setting of Severe Lumbar Kyphosis

BACKGROUND

Severe kyphosis is infrequently seen in neonates with myelomeningoceles. Spinal skeletal dysmorphology complicates repair, as local tissue may be insufficient to cover the dural repair. Although neonatal kyphectomy has been proposed as a potential solution to this problem, it carries significant potential risks that may not be acceptable to families.

CASE DESCRIPTION

A neonate presented with a large myelomeningocele defect with associated severe lumbar kyphosis. Kyphectomy was both declined by the family owing to the potential surgical risks and deemed not appropriate by the surgeons based on the challenging anatomic considerations. Soft tissue closure was not possible with local tissue rearrangement. Acellular dermal matrix was used as a definitive soft tissue coverage option, with complete epithelialization noted at 8 weeks postoperatively.

CONCLUSIONS

Acellular dermal matrix is a potentially useful adjunct for definitive reconstruction of complex neonatal soft tissue defects where local tissue is not available.