Reconstruction of Myelomeningocele by Lumbar Artery Perforator Plus Flap: Retrospective Analysis of Case Series | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 6, Volume 47, Issue 4, October 2023, Page 275-282 PDF (16.11 MB) | ||||
| Document Type: Research article | ||||
| DOI: 10.21608/ejprs.2023.319957 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Mohamed Al Sabbahi* 1; Safwat Abou Hashem2; Ashraf M Mostafa3 | ||||
| 1The Departments of Plastic & Reconstructive Surgery, School of Medicine, Zagazig University, Egypt, and Saudi German Hospital, Riyadh | ||||
| 2The Departments of Neurosurgery, School of Medicine, Zagazig University and Department Neurosurgery, Saudi German Hospital, Riyadh | ||||
| 3The Department of Plastic & Reconstructive Surgery, School of Medicine, Zagazig University, Egypt, | ||||
| Abstract | ||||
| Background: Over the last two decades, a paradigm shift has occurred in the reconstruction of myelomeningocele defects with the emerging concepts of perforator flaps. The use of lumbar perforator flaps for reconstruction of those defects has superseded any other modes of reconstruction. This is attributed to the confidence in flap versatility and low donor site morbidity. Although the flap has good vascular reliability, there's still some risk for venous congestion. Objectives: This study aims to present our experience and the outcome in the reconstruction of myelomeningocele defects using freestyle lumbar perforator plus flap. Methods: Retrospective analysis of 16 newly born infants presented to the plastic surgery department between February 2018 to June 2020 presented with thoracolumbar, lumbosacral, or purely lumbar myelomeningocele. All patients underwent joint neurosurgical and plastic reconstruction procedures. Layered reconstruction was performed and dorsal intercostal or lumbar arteries perforator plus flap were used in all patients. Results: Out of the 16 babies in this study, 15 babies (93.75%) had neurological deficits. The flap dimension ranged from (3.4x5.8cm) to (6x11cm). The blood loss was minimal with a mean of 22±4.5ml. No flap loss had occurred except for one partial 1cm distal necrosis treated conservatively. Follow-up for six months showed good soft tissue coverage in all cases without any need for further reconstructive procedures. Conclusion: The lumbar artery perforator plus flap provides a well vascularized durable coverage, lower rate of complications or morbidity and more aesthetic appearance. | ||||
| Keywords | ||||
| Myelomeningocele; Perforator plus; Lumbar artery; Dorsal intercostal artery flap | ||||
| References | ||||
|
Copp A.J., Adzick N.S., Chitty L.S., et al.: Spina bifida. Nat. Rev. Dis. Primers, 1: 15007, 2015. 2- Turhan Haktanir N., Eser O., Demir Y., et al.: Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method. Turk Neurosurg, 18: 311-315, 2008. 3- Lapid O., Rosenberg L. and Cohen A.: Meningomyelocele reconstruction with bilobed flaps. Br. J. Plast. Surg., 54: 570-572, 2001. 4- Shaer C.M., Chescheir N. and Schulkin J.: Myelomeningocele: A review of the epidemiology, genetics, risk factors for conception, prenatal diagnosis, and prognosis for affected individuals. Obstet. Gynecol. Surv., 62: 471-479, 2007. 5- Dias M. and Lane J.: Myelomeningocele Closure: An Embryological Perspective. Cureus, 12: e9682, 2020. 6- Atalay T., Oktay K., Guzel E., et al.: Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair. Childs Nerv. Syst., 37: 229- 233, 2021. 7- Cologlu H., Ozkan B., Uysal A.C., et al.: Bilateral propeller flap closure of large meningomyelocele defects. Ann. Plast. Surg., 73: 68-73, 2014. 8- Isik D., Tekes L., Eseoglu M., et al.: Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann. Plast. Surg., 67: 159-163, 2011. 9- UCAK M.: Myelomeningocele closure by unilateral lumbar artery perforator flap: Experience with thirty-eight patients. Microsurgery, 38: 752-757, 2018. 10- Emsen I.M.: Closure of Large Myelomeningocele Defects Using the O-S Flap Technique. J. Craniofac. Surg., 26: 2167-2170, 2015. 11- Duffy F.J., Jr., Weprin B.E. and Swift D.M.: A new approach to closure of large lumbosacral myelomeningoceles: The superior gluteal artery perforator flap. Plast Reconstr Surg., 114: 1864-1868; discussion 1869-1870, 2004. 12- Zakaria Y. and Hasan E.A.: Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J. Plast. Reconstr. Aesthet. Surg., 63: 1513-1518, 2010. 13- Cruz N.I., Ariyan S., Duncan C.C., et al.: Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note. J. Neurosurg., 59: 714-717, 1983. 14- Lien S.C., Maher C.O., Garton H.J., et al.: Local and regional flap closure in myelomeningocele repair: A 15- year review. Childs Nerv. Syst., 26: 1091-1095, 2010. 15- Kato H., Hasegawa M., Takada T., et al.: The lumbar artery perforator based island flap: Anatomical study and case reports. Br. J. Plast. Surg., 52: 541-546, 1999. 16- El-Sabbagh A.H. and Zidan A.S.: Closure of large myelomeningocele by lumbar artery perforator flaps. J. Reconstr. Microsurg., 27: 287-294, 2011. 17- Tenekeci G. and Basterzi Y.: Reliability of extended dorsal intercostal artery perforator propeller flaps for reconstruction of large myelomeningocele defects. J. Plast. Reconstr. Aesthet. Surg., 70: 60-66, 2017. 18- Gutierrez-Ontalvilla P., Blanco E.L. and Miranda P.: Longterm follow-up of myelomeningocele defect closure with dorsal intercostal artery perforator propeller flaps. Childs Nerv. Syst., 35: 1219-1222, 2019. 19- Luce E.A., Stigers S.W., Vandenbrink K.D., et al.: Splitthickness skin grafting of the myelomeningocele defect: A subset at risk for late ulceration. Plast. Reconstr. Surg., 87: 116-121, 1991. 282 Vol. 47, No. 4 / Reconstruction of Myelomeningocele by Lumbar Artery Perforator Plus Flap 20- Mustarde J.C.: Meningomyelocele: The problem of skin cover. Br. J. Surg., 53: 36-41, 1966. 21- Moore T.S., Dreyer T.M. and Bevin A.G.: Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast. Reconstr. Surg., 73: 288- 292, 1984. 22- Ulusoy M.G., Kocer U., Sungur N., et al.: Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps. Ann. Plast. Surg., 54: 640-644, 2005. 23- Patterson T.J.: The use of rotation flaps following excision of lumbar myelo-meningoceles: An aid to the closure of large defects. Br. J. Surg., 46: 606-608, 1959. 24- Muneuchi G., Matsumoto Y., Tamai M., et al.: Rhomboid perforator flap for a large skin defect due to lumbosacral meningocele: A simple and reliable modification. Ann. Plast. Surg., 54: 670-672, 2005. 25- Atik B., Tan O., Kiymaz N., et al.: Bilobed fasciocutaneous flap closure of large meningomyeloceles. Ann. Plast. Surg., 56: 562-564, 2006. 26- Cho E.H., Shammas R.L., Carlsen B.T. and Allen R.J.: Perforator Plus breast reconstruction: A comparative study. J. Plast. Reconstr. Aesthet. Surg., Nov. 66 (11): 1452-9, 2013. 27- Farber N., Kim K., Patel A., et al.: Comparison of Perforator Plus and Muscle-sparing Transverse Rectus Abdominis Myocutaneous Flaps for Unilateral Breast Reconstruction: A Single-Institution Experience. J. Reconstr. Microsurg., Nov. 33 (9): 623-628, 2017. 28- Egro F.M., Galié M., Spaggiari A., et al.: Perforator plus flaps versus fasciocutaneous flaps for reconstruction of lower extremity defects: A comparison of outcomes. J. Plast. Reconstr. Aesthet. Surg., Nov. 67 (11): 1496-503, 2014. | ||||
|
Statistics Article View: 238 PDF Download: 405 |
||||
