[Expansion for skin closure of large myelomeningoceles]
Djaffar Ould-Ali1, Bruno Salazard2, Jonathan Londner1
1Unité de chirurgie plastique pédiatrique, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Insights
Closure of large myelomeningoceles can be achieved with cutaneous expansion, a technique that provides stable, durable results and preserves tissue for children at risk of pressure sores.
Area of Science:
- Pediatric Neurosurgery
- Plastic and Reconstructive Surgery
Context:
- Myelomeningocele closure demands stable, durable dural reconstruction.
- Large myelomeningoceles present significant surgical challenges.
Purpose:
- To evaluate the efficacy of reconstructive techniques for large myelomeningocele closure.
- To assess outcomes of cutaneous expansion and flap surgery in pediatric patients.
Summary:
- Six pediatric myelomeningocele cases underwent reconstructive surgery, including cutaneous expansion (4 cases) and rotational fasciocutaneous flap (1 case).
- Techniques provided stable, durable closure with up to 11 years follow-up.
- One case of prosthesis exposure without infection occurred.
Impact:
- Cutaneous expansion is effective for late closure of large myelomeningoceles.
- This method minimizes wound healing issues and conserves tissue resources.
- Preserves tissue for children susceptible to pressure sores.
Background:
Closure of a large myelomeningocele requires stable durable coverage of the dural reconstruction.
Methods:
Twenty-seven cases of myelomeningoceles have been treated in the department of pediatric neurosurgery at the Timone Children's Hospital in the last 17 years. Six children have undergone plastic and reconstructive surgery. Among these six children, four were received several months after birth with a large myelomeningocele and underwent cutaneous expansion prior to closure. One child received lateral discharge incisions during the neonatal period. The sixth child, received at 15 years of age for persistent CSF leak despite numerous attempts to close the dura, was treated by rotational dorsal fasciocutaneous flap with dural plastic surgery.
Results:
In all of the cases, these techniques provided stable and durable closure with a maximum follow-up of 11 years. An expansion complication was observed with exposure of the prosthesis without secondary infection.
Conclusions:
Cutaneous expansion is the technique of choice for late closure of large myelomeningoceles. It makes it possible to limit wound-healing problems and preserve muscle and skin resources in children who risk pressure sores.
