Closure of Large Myelomeningocele by Lumbar Artery Perforator Flaps

ABSTRACT

Myelomeningocele is the most complex congenital malformation of the central nervous system that is compatible with life. Different closure techniques are available for defect reconstruction, but wound healing and tension-free closure of the skin in the midline remain major considerations in large myelomeningoceles. In this study, bilateral lumbar artery perforator flaps were used for closure of large myelomeningocele defects. Fifteen infants and neonates with large myelomeningocele defects were enrolled in the study. The lumbar artery perforator flaps were elevated bilaterally or unilaterally and advanced toward the midline without tension and were sutured together. Most of the flaps healed without any major complication. The lumbar artery perforator flaps as is an effective method for closure of large myelomeningocele defects.

KEYWORDS

Myelomeningocele - large - lumbar artery perforator flap

REFERENCES

• 1 Erickson J D. Folic Acid and Prevention of Spina Bifida and Anencephaly. MMWR 51 (RR-13). Washington, DC: GPO; 2002: 9-11
• 2 Shurtleff D, Stuntz J T. Back closure. In: Shurtleff D B, ed. Myelodysplasias and Extrophies: Significance, Prevention and Treatment. New York: Grune & Stratton; 1986: 117-138
• 3 Moore T, Dreyer T, Bevin G. Closure of large spina bifida cystica defects with bilateral bipedicled musculocutanous flaps.  Plast Reconstr Surg. 1983;  73 288-292
• 4 Luce E A, Walsh J. Wound closure of the myelomeningocoele defect.  Plast Reconstr Surg. 1985;  75 389-393
• 5 Cheek W R, Laurent J P, Cech D A. Operative repair of lumbosacral myelomeningocele. Technical note.  J Neurosurg. 1983;  59 718-722
• 6 McCraw J B, Penix J O, Baker J W. Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap.  Plast Reconstr Surg. 1978;  62 197-206
• 7 Bostwick III J, Scheflan M, Nahai F, Jurkiewicz M J. The “reverse” latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations.  Plast Reconstr Surg. 1980;  65 395-399
• 8 Muldowney J B, Magi E, Hein K, Birdsell D. The reverse latissimus dorsi myocutaneous flap with functional preservation—report of a case.  Ann Plast Surg. 1981;  7 150-151
• 9 Stevenson T R, Rohrich R J, Pollock R A, Dingman R O, Bostwick III J. More experience with the “reverse” latissimus dorsi musculocutaneous flap: precise location of blood supply.  Plast Reconstr Surg. 1984;  74 237-243
• 10 Hill H L, Brown R G, Jurkiewicz M J. The transverse lumbosacral back flap.  Plast Reconstr Surg. 1978;  62 177-184
• 11 Kato H, Hasegawa M, Takada T, Torii S. The lumbar artery perforator based island flap: anatomical study and case reports.  Br J Plast Surg. 1999;  52 541-546
• 12 Cruz N I, Ariyan S, Duncan C C, Cuono C B. Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note.  J Neurosurg. 1983;  59 714-717
• 13 Luce E A, Stigers S W, Vandenbrink K D, Walsh J W. Split-thickness skin grafting of the myelomeningocele defect: a subset at risk for late ulceration.  Plast Reconstr Surg. 1991;  87 116-121
• 14 Luce E A, Walsh J. Wound closure of the myelomeningocoele defect.  Plast Reconstr Surg. 1985;  75 389-393
• 15 Moore T S, Dreyer T M, Bevin A G. Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps.  Plast Reconstr Surg. 1984;  73 288-292
• 16 Campobasso P, Pesce C, Costa L, Cimaglia M L. The use of the Limberg skin flap for closure of large lumbosacral myelomeningoceles.  Pediatr Surg Int. 2004;  20 144-147
• 17 Ulusoy M G, Koçer U, Sungur N et al.. Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps.  Ann Plast Surg. 2005;  54 640-644
• 18 Cruz N I, Ariyan S, Duncan C C et al.. Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps.  J Neurosurg. 1983;  59 714-717
• 19 Campobasso P, Pesce C, Coasta L, Cimaglia M L. The use of the Limberg skin flap for closure of large lumbosacral myelomeningoceles.  Pediatr Surg Int. 2004;  20 144-147
• 20 Ulusoy M G, Kocer U, Sungur N et al.. Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps.  Ann Plast Sug. 2005;  54 640-644
• 21 Lien S C, Maher C O, Garton H J, Kasten S J, Muraszko K M, Buchman S R. Local and regional flap closure in myelomeningocele repair: a 15-year review.  Childs Nerv Syst. 2010;  26 1091-1095
• 22 de Weerd L, Weum S. The butterfly design: coverage of a large sacral defect with two pedicled lumbar artery perforator flaps.  Br J Plast Surg. 2002;  55 251-253
• 23 Kroll S S, Rosenfield L. Perforator-based flaps for low posterior midline defects.  Plast Reconstr Surg. 1988;  81 561-566
• 24 Kiil B J, Rozen W M, Pan W R et al.. The lumbar artery perforators: a cadaveric and clinical anatomical study.  Plast Reconstr Surg. 2009;  123 1229-1238