Keystone design perforator island flap for closure of myelomeningocele
Matthew J Gutman1, Tony Goldschlager, Rostam D Fahardieh
1Department of Surgery, Monash Medical Centre, Clayton, VIC, Australia. matthewjgutman@gmail.com
Insights
The keystone design perforator island flap (KDPIF) offers a robust solution for closing larger myelomeningocele (MMC) defects. This novel approach demonstrated excellent wound healing and no complications in a series of infant repairs.
Area of Science:
- Neurosurgery
- Plastic Surgery
- Pediatric Surgery
Background:
- Myelomeningocele (MMC) repair presents challenges, especially for larger defects, due to potential tension and inadequate soft tissue cover.
- Traditional closure methods can lead to complications like scar stretching and poor wound healing.
Purpose of the Study:
- To evaluate the efficacy and safety of the keystone design perforator island flap (KDPIF) for primary closure of myelomeningocele in infants.
- To present the first recorded use of KDPIF for primary myelomeningocele closure.
Main Methods:
- A retrospective analysis of three infants undergoing KDPIF for myelomeningocele repair at birth was conducted.
- Data were sourced from the Monash Neurosurgical Database between December 2008 and September 2010.
Main Results:
- All three infants experienced prompt and satisfactory wound healing following KDPIF closure.
- No complications, including flap separation, necrosis, infection, or cerebrospinal fluid leak, were observed.
- The KDPIF demonstrated superior tissue bulk, vascularity, and versatility compared to traditional flaps.
Conclusions:
- The keystone design perforator island flap serves as a viable alternative for closing larger and more complex myelomeningocele defects.
- KDPIF offers a robust solution with excellent outcomes, addressing limitations of conventional closure techniques.
Object:
We present a series of three infants who underwent keystone design perforator island flap (KDPIF) closure for myelomeningocele in a paediatric neurosurgical centre in Australia. This is the first recorded utilization of this flap for primary closure of myelomeningocele (MMC).
Methods:
The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2010. Retrospective analysis of these cases revealed three patients who underwent KDPIF at Monash Medical Centre for MMC repair at birth.
Results:
Wound healing was prompt and satisfactory in all three cases. No minor or major complications were noted. In particular, there was no associated skin flap separation, skin flap dehiscence, skin flap necrosis, infection, cerebrospinal fluid leak, or need for return to theatre for further intervention to the wound. This keystone design perforator island flap is based on random perforating musculo/fasciocutaneous perforators. In our experience, this robust flap provides better tissue bulk, more reliable vascularity and a wider geometrical versatility than traditional random 1:1 cutaneous flaps.
Conclusion:
Whilst primary closure remains an option for myelomeningocele closure, primary repair of larger defects can lead to closure site tension, stretching of inelastic scar tissue and inadequate soft tissue cover. In this small series, we have demonstrated the use of keystone design perforator island flap closure as an alternative for larger and more complex lesions.
