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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
How much do plastic surgeons add to the closure of myelomeningoceles?
Rhian Bevan1, Nicholas Wilson-Jones2, Imran Bhatti3
1University Hospital of Wales College of Medicine, Cardiff, UK. bevanr8@cardiff.ac.uk.
Insights
This study found that involving plastic surgeons in all myelomeningocele (MMC) repairs resulted in a low rate of wound complications. This collaborative approach aids in successful MMC closure outcomes for pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Plastic Surgery
- Spina Bifida Research
Background:
- Myelomeningocele (MMC) repair is a complex neurosurgical procedure.
- Historically, pediatric neurosurgeons perform MMC closures, sometimes with plastic surgeon support for extensive defects.
- The role of routine plastic surgeon involvement in MMC repair outcomes is not well-defined.
Purpose of the Study:
- To evaluate the impact of plastic surgeon presence on postoperative outcomes in pediatric myelomeningocele (MMC) repair.
- To assess the efficacy and complication rates associated with all MMC closures performed with plastic surgeon support.
- To compare outcomes with existing literature on MMC repair complications.
Main Methods:
- A prospective database of 31 pediatric myelomeningocele (MMC) closures from April 2009 to August 2017 was analyzed.
- Outcomes were reviewed, focusing on wound complications, cerebrospinal fluid (CSF) leaks, and the need for complex closure techniques.
- Data was compared with published literature on MMC repair outcomes.
Main Results:
- Twenty-four (77.4%) MMC defects were closed by direct approximation; seven (22.5%) required complex plastic procedures.
- A low overall wound complication rate of 6.5% was observed (one infection, one flap edge necrosis), both managed conservatively.
- Two patients (6.5%) experienced cerebrospinal fluid (CSF) leaks, successfully treated with shunting; two deaths occurred from unrelated causes.
Conclusions:
- The study observed a low wound complication rate in pediatric myelomeningocele (MMC) repairs, with 22.5% requiring complex closure.
- The authors attribute the favorable wound complication rate to the consistent involvement of plastic surgeons in all MMC closure procedures.
- Routine plastic surgeon participation may enhance outcomes and reduce complications in myelomeningocele (MMC) repair.
Purpose:
This study reviews the outcomes of children undergoing myelomeningocele (MMC) repair in the paediatric neurosurgical department in Cardiff. These procedures are historically performed by paediatric neurosurgeons with occasional support from plastic surgeons for the larger lesions. We reviewed the postoperative outcomes over a 9-year period to assess the efficacy of having a plastic surgeon present at all MMC closures.
Methods:
Analysis of a prospectively collected database of all MMC closures performed at University Hospital Wales from April 2009 to August 2017 was used. Comparison was made with the published literature especially with regard to complications.
Results:
Thirty-one children, 13 males and 18 females, underwent MMC closure over the 9-year period. Twenty-four (77.4%) defects were closed by direct approximation. Seven patients (22.5%) required a more complex plastic procedure to obtain closure. Two patients (6.5%) had a wound complication, one wound infection and one flap edge necrosis both healing with dressings alone. Two patients had cerebrospinal fluid (CSF) leaks that responded to ventriculo-peritoneal shunting. Two patients died from unrelated conditions during the study period.
Conclusion:
In our series, 7/31 (22.5%) cases involved a more complex closure in keeping with the literature. The authors feel that having the plastic surgeon at all closures has led to a low wound complication rate.
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