Primary vs patch-based skin closure for in-utero spina bifida repair
M Fishel Bartal1, E P Bergh1, K Tsao2
1The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Summary
Patch-based closure for spina bifida (SB) repair, often necessary for myeloschisis, leads to longer surgery times, extended neonatal intensive care unit (NICU) stays, and increased wound revisions in the first year. Further research is needed for optimal patch selection.
Area of Science:
- Fetal surgery
- Neonatal outcomes
- Spina bifida repair
Background:
- Closure of large defects during in-utero spina bifida (SB) repair can be challenging, often necessitating tissue grafts.
- No previous studies have directly compared primary skin closure with patch-based repair for prenatal SB repair.
Purpose of the Study:
- To compare neonatal and 1-year outcomes between primary skin closure and patch-based closure techniques for in-utero SB repair.
Main Methods:
- A prospective cohort study included 102 patients undergoing open prenatal SB repair.
- Patients were divided into primary skin closure (n=70) and patch-based closure (n=32) groups.
- Neonatal and 1-year outcomes were compared between the two groups.
Main Results:
- Patch-based closure was more common in fetuses with myeloschisis and involved longer surgical times (median 37 vs 33 min).
- Neonates receiving patch-based repair had significantly longer NICU stays (24 days longer).
- Wound revision within the first year was more frequent in the patch-based group (19.4% vs 5.1%).
Conclusions:
- Patch-based closure for SB repair is associated with prolonged surgery, extended NICU stays, and higher rates of wound revision.
- Further investigation is required to identify optimal patches or alternative methods for improving outcomes in SB repair.
