A Simplified Approach to Myelomeningocele Defect Repair
Owen H Brown1, Katelyn G Makar1, Raquel M Ulma1
1From the Section of Plastic Surgery.
Background:
Repair of the soft tissue defect in myelomeningoceles remains challenging. The literature currently lacks a systematic approach, reporting high rates of complications. We present outcomes from the largest series to date and describe a simplified approach that minimizes morbidity and streamlines decision making.
Methods:
Patients 1 year or younger who underwent myelomeningocele repair between 2008 and 2018 were reviewed. Flap types were categorized by tissue composition. Complications were dichotomized into early and late (<30 days and >30 days postoperative, respectively). Logistic regression was used to measure the impact of flap tissue composition and skin closure technique on odds of postoperative complications.
Results:
Ninety-seven patients met inclusion criteria. Reoperation was required in only 3 (3.0%) patients-1 for wound dehiscence and 2 for surgical site infections. Zero cases of tethered cord or cerebrospinal fluid leak occurred. The most common minor complications were early wound complications (n = 18, 18.6%) and early infection (n = 5, 5.2%). Fascia-only flaps and muscle + other tissue flaps were not associated with higher odds of complications compared with muscle-only flaps (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.53-8.50, P = 0.29; OR = 2.87, 95% CI 0.66-12.51, P = 0.16, respectively). Rhomboid flaps for skin closure were associated with higher odds of complications (OR, 4.47; 95% CI, 1.00-19.97; P = 0.05).
Conclusions:
Our approach to myelomeningocele repair demonstrated no cases of secondary tethered cord or cerebrospinal fluid leak, and reoperative rates were extremely low. Because complications were unrelated to flap type, we recommend a simplified approach using any tissue type for dural coverage and 2-layer primary closure of the skin.
Insights
Myelomeningocele repair is simplified with a new approach, showing very low complication rates and no cases of tethered cord or cerebrospinal fluid leak. This method streamlines decision-making for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Plastic Surgery
Background:
- Myelomeningocele repair presents significant challenges with high complication rates.
- Existing literature lacks a systematic approach for soft tissue defect repair.
- This study introduces a simplified method to minimize morbidity.
Purpose of the Study:
- To evaluate outcomes of a simplified myelomeningocele repair technique.
- To identify factors influencing postoperative complications.
- To reduce morbidity and streamline decision-making in myelomeningocele repair.
Main Methods:
- Retrospective review of 97 patients aged 1 year or younger undergoing myelomeningocele repair (2008-2018).
- Categorization of flap types by tissue composition and analysis of early/late complications.
- Logistic regression to assess the impact of flap tissue and skin closure on complication rates.
Main Results:
- Only 3.0% of patients required reoperation; zero cases of tethered cord or CSF leak occurred.
- Early wound complications (18.6%) and infection (5.2%) were the most common minor issues.
- Flap tissue composition did not significantly impact complication rates, but rhomboid flaps increased complication odds (P=0.05).
Conclusions:
- The simplified myelomeningocele repair approach resulted in no secondary tethered cord or CSF leaks.
- Reoperation rates were notably low, suggesting a safe and effective technique.
- Recommends using any tissue type for dural coverage and two-layer skin closure, as flap type did not correlate with complications.
