Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques)

The large myelomeningocele defects that cannot be closed reliably by simple skin undermining require a close cooperation between the neurosurgeon and the plastic surgeon. In this study, a 3-year review was undertaken of nine consecutive patients with a myelomeningocele defect treated in our hospital. The aim of the study was to analyze the size, location of myelomeningocele defects, features of the surrounding tissue, and type and results of the reconstruction method for skin closure. Of the nine patients, five were repaired within the first 48 h of life, two within the 1st month of life, and two were repaired within the 1st year of life. Of the nine patients, seven (78%) underwent repair with direct skin approximation by the Neurosurgical Service. For three patients (33%) with large lumbosacral meningomyelocele defects, including one patient who had failed direct skin approximation, the Plastic Surgery Service achieved the skin closure by bilateral paralumbar fasciocutaneous rotational flaps. Minimal area in the patients referred to the Plastic Surgery Service was 24 cm(2) ( range 24 - 48 cm(2)); patients having 18 cm2 or less skin defect were not referred for closure. In conclusion, fasciocutaneous rotational flaps provided tension-free, durable, innervated and well-vascularized skin coverage over the dural repair in all three referred patients, without using skin graft. Since myelomeningocele defects vary in size, shape, and location, no single procedure applies to all. Therefore, other reconstruction methods involving skin grafts, fasciocutaneous flaps, and musculocutaneous flaps are reviewed in this report.