Reconstructions With Different and New Techniques of Large and Extensive Myelomeningocele Defects

Myelomeningocele and/or meningocele is a defect of spine and spinal cord, and it is congenital. Although meningocele is a mild form of spina bifida, myelomeningocele is a more complex and serious form. There is a sac in both forms at the back. Difference is that myelomeningocele contains neural structures or spinal cord elements, and meningocele does not contain these neural or spinal cord elements.

Between 2012 and 2018, 77 (45 females, 32 males) newborns with myelomeningocele were operated by mean age 35 days. The O-S flap (26 patients) method was used in patients who have circular defect. The Emsen 1 flap (31 patients) was used in patients who have elliptic defect. The Emsen 2 flap (20 patients) was also used in patients who have triangular defect. Mean follow-up was 22 months (9-50 months).

A successful tension-free closure was made with these methods. Defects of the newborn were divided the subgroups as circular, elliptic, and triangular. Hydrocephalus was detected in 19 patients. Ventriculoperitoneal shunt was done at the same time with the myelomeningocele surgical procedure. All complications were noted in patients with hydrocephalus such as cerebrospinal fluid leakage (in 8 patients), wound infection (in 3 patients), and partially wound dehiscence (in 4 patients).

There are many techniques about myelomeningocele closure in literature. The problem is not number of techniques. Literature presents different geometric flap design, muscle flaps, and musculocutaneous flaps on these defects. Large or extensive skin defects need more complex flap methods, and unfortunately, number of these is too limited. Three methods on large or extensive myelomeningocele skin defects are presented in this study. With these flaps, large or extensive skin defects could be easily closed. In all techniques, major advantages are no skin grafting, no abnormal blood loss, no muscle sacrificing, short operation time, and most important one is that 1-step surgery could be sufficient.