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Reconstruction of Large Meningomyelocele Defects With Rotation-Transposition Fasciocutaneous Flaps

Selçuk, Caferi Tayyar MD*; Civelek, Birol MD; Bozkurt, Mehmet MD*; Kapi, Emin MD*; Kuvat, Samet Vasfi MD*

doi: 10.1097/SAP.0b013e31822592c4
Reconstructive Surgery
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Meningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery to prevent complications such as primary meningitis and to protect the neural tissues. The most important factors in the surgical treatment of meningomyelocele defects are the size of the defect, its location, the presence of kyphosis, and the quality of the surrounding tissue. The chosen method must be a simple one that causes minimal blood loss, requires a short duration of surgery, and covers the surface of the neural defect with a soft-tissue mass enabling closure without tension. In our study, satisfactory results have been obtained using 1 or 2 fasciocutaneous flaps based on the midline in 20 patients with large meningomyelocele defects where primary closure was not possible. A single flap based superiorly on the midline was sufficient to close the defects in patients without kyphosis. In patients with concurrent kyphosis, a second flap based inferiorly on the midline has been used. All flaps survived, except for a distal partial necrosis observed in 1 patient. In the method we used, we adopted a defect reconstruction that is similar to the normal anatomic structures and resistant to trauma and infections, and does not sacrifice any muscle tissue. According to our clinical experiences, this method is useful for large meningomyelocele defects that are unsuitable for primary closure.

From the *Department of Plastic Reconstructive and Aesthetic Surgery and Burn Center, Dicle Medical Faculty, Diyarbakir, Turkey and †Keçiören Training and Research Hospital, Ankara, Turkey.

Received February 8, 2011, and accepted for publication, after revision, May 20, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Selcuk Caferi Tayyar, MD, Dicle University Medical Faculty, Department of Plastic Reconstructive and Aesthetic Surgery and Burn Center, 21280, Diyarbakir, TURKEY. E-mail: tayyarselcuk@hotmail.com.

© 2012 Lippincott Williams & Wilkins, Inc.