Reconstruction of Large Meningomyelocele Defects with Local Fasciocutaneous Flaps

Abstract

Objective: To determine the versatility and safety of local fasciocutaneous flaps for reconstruction of large meni-ngomyelocele defects in terms of flap survival and dural coverage.
Materials and Methods: Meningomyelocele is a congenital defect in the vertebral arches with cystic dilatation of meninges. Closure of the skin defect in broad based meningomylocele is a challenging reconstructive problem. We present our experience of use of local fasciocutaneous flaps for coverage of skin defects in meningomyelocele patients. In this descriptive case series we managed 15 patients with broad based myelomeningocele defects in the Plastic & Reconstructive Surgery department Lahore General Hospital, Lahore from March 2008 to April 2016. The age of patients ranged from 4 days to 8 years. The diameter of the defect ranged between 8×5 to 13×8 cm. In all patients, reconstruction of soft tissue defect was done with local fasciocutaneous flaps. We performed Double Z-plasty in 2 (13%) patients, bilateral transposition flap in 4 (26%) patients, bipedicle skin flap in 4 (26%) pati-ents, unilateral long superiorly based flap in 3 (20%) patients, and inferiorly based flap based on gluteal perfo-rator in 2 (13%) patients. Donor site was primarily closed in 10 (66%) patients.
Results: In 5 (33%) patients flap donor area was skin grafted. Superficial wound dehiscence was seen in 2 (13%) patients. One patient (6%) had necrosis of distal part of flap which was managed conservatively. No neuro-surgical complication occurred post operatively. Average follow up of 2 years showed no recurrence or dural sac herniation in any patient.
Conclusion: Reconstruction of large meningomyelocele defects with local fasciocutaneous flaps provides safe and predictable outcomes and is the method of choice for most of the defects in the lumbosacral area.