Large Meningomyelocele Defects Reconstruction Using Double Opposing Fasciocutaneous Flaps

ABSTRACT

When a part of neural tube fails to develop or close properly, it manifests as spina bifida. Spina bifida defects range from the mild form (spina bifida occulta) to severe form (meningomyelocele). Meningomyelocele is to be closed surgically as early as possible to prevent infection and other complications. Many methods are available for treatment of meningomyelocele defects ranging from skin graft to flap cover. Meningomyelocele defects when small in size can be closed primarily. Large meningomyelocele defects poses technical challenge to reconstructive surgeon. Many flap cover techniques were described to cover the large meningomyelocele defects. We wanted to evaluate bilateral opposing fasciocutaneous flaps method for closure of large defects without tension.METHODSTo cover large meningomyelocele defects, fasciocutaneous flaps give good and stable cover, and prevents wear and tear, and infections. We have used double opposing fasciocutaneous flaps method for reconstruction of large meningomyelocele defects. The advantages of this technique are its simplicity and it being a single stage procedure. 20 children with meningomyelocele defects of various sizes were operated with this method and followed for 6 months for wound dehiscence and CSF leak.RESULTSClosure of large meningomyelocele defects is made possible with simple and easy technique. Ease of planning and execution even for the inexperienced are the most noticeable features. All children were well post operatively. Two patients in whom flaps were taken with acute angles suffered tip necrosis. All flaps gave stable cover to the defect without dehiscence at the suture line. The entire reconstructive process consumed less time and was without major complications.CONCLUSIONSNeural tube malformation congenitally causes spina bifida defects. Spina bifida cases may range from simple to severe defects. Treatment of meningomyelocele spans from primary closure to flap cover closure. Closure of large meningomyelocele defect by bilateral fasciocutaneous flaps is a good method to adopt. This method is simple, less time consuming, technically non-demanding and easily reproducible.