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Closure of large myelomeningocoele with Ramirez technique
Maciej Bagłaj1, Jolanta Ladogórska, Konrad Rysiakiewicz
1Department of Pediatric Surgery, Medical University, M. Sklodowska 52, Wroclaw, 50-367, Poland. baglaj@chdz.am.wroc.pl
Introduction:
The authors present their 7-year experience in operative closure of large open myelomeningocoele with a technique introduced by Ramirez et al. in 1986. It consists of medial advancement of bilateral bipedicled musculocutanous flap based on the latissimus dorsi and maximus gluteus without any relaxing incisions or skin grafting.
Results And Discussion:
Thirty-five babies were operated on according to this technique on first day of life. In 16 cases, large thoracic or thoracolumbosacral defect was noted, while in further 19 newborns, lumbosacral or lumbar defect occurred. The dimensions of the entire defect ranged from 4.8x5 to 8x10.8 cm. In seven babies, the affected area had more than 50 cm(2). In all patients, three-layer tension-free closure of the dorsal wound was performed in one stage. The mean operative time was 115 min (90-195 min). All but two wounds healed uneventfully. In two babies with wide lumbosacral defects, minor skin necrosis with wound dehiscence was noted which subsequently required conservative treatment. Follow-up period ranges from 6 months to 7 years. In none of the 32 children was any late complication of the reconstructive procedure noted.
Conclusion:
Ramirez technique is a very reliable method of closure of myelomeningocoele regardless of the size of the defect and its topography. It may find a wide application in babies affected by neural tube defect.
Insights
The Ramirez technique offers reliable, single-stage closure for large myelomeningocele defects in newborns, with excellent healing outcomes and no late complications observed in a 7-year study.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Reconstructive Surgery
Background:
- Myelomeningocele repair presents significant surgical challenges, particularly for large defects.
- The Ramirez technique, utilizing bilateral bipedicled musculocutaneous flaps, was introduced in 1986 for complex closures.
Purpose of the Study:
- To evaluate the 7-year experience and outcomes of the Ramirez technique for operative closure of large open myelomeningocele.
- To assess the reliability and applicability of this method in neonates with neural tube defects.
Main Methods:
- A retrospective review of 35 neonates undergoing myelomeningocele closure using the Ramirez technique.
- The technique involves medial advancement of latissimus dorsi and gluteus maximus flaps without relaxing incisions or skin grafting.
- Closure was performed in a single stage, focusing on tension-free repair.
Main Results:
- Thirty-five neonates with defects ranging from 4.8x5 cm to 8x10.8 cm were treated.
- All closures were performed in one stage, with a mean operative time of 115 minutes.
- Two cases (5.7%) experienced minor skin necrosis and wound dehiscence requiring conservative management; the remaining 33 healed uneventfully.
Conclusions:
- The Ramirez technique is a highly reliable method for closing myelomeningocele defects of varying sizes and locations.
- This single-stage, tension-free closure shows excellent short-term and long-term results, with no late reconstructive complications noted.
- The technique demonstrates wide applicability for neonates with neural tube defects, offering a robust surgical solution.
