Large myelomeningocele repair

Area of Science:

• Pediatric Surgery
• Neurosurgery
• Wound Management

Background:

• Myelomeningocele (MMC) repair presents challenges, especially for large defects where standard closure techniques are insufficient.
• Traditional wound undermining may lead to complications in extensive MMC cases.
• Developing effective surgical strategies for large MMC defects is crucial for reducing adverse outcomes.

Purpose of the Study:

• To report surgical experiences and recommendations for managing large myelomeningocele (MMC) defects.
• To present a technique aimed at decreasing wound complications in pediatric MMC patients.
• To evaluate the efficacy of specific surgical modifications for large MMC closure.

Main Methods:

• Surgical repair of large MMC defects in 40 pediatric patients.
• Utilization of available hairy skin surrounding the defect to minimize wound edge tension.
• Implementation of vertical flank incisions and simultaneous ventriculo-peritoneal shunting in select cases.

Main Results:

• Successful tension-free closure of large MMC defects was achieved in the majority of patients.
• Three patients experienced superficial skin infection and partial wound dehiscence, managed conservatively.
• The study included patients aged 2 days to 8 years, with thoracolumbar MMC and lower extremity weakness being common.

Conclusions:

• Maximizing the use of hairy skin around the MMC defect is recommended for closure.
• Release incisions on flanks and simultaneous ventriculo-peritoneal shunting are advised for high-risk cases.
• These techniques facilitate successful MMC closure without significantly increasing surgical time or cost.