Outcomes of myofascial flap closure following complex tethered cord release in pediatric patients
Nancy Qin1, Yunchan Chen1, Daniella De Freitas1
1Division of Plastic and Reconstructive Surgery, Weill Cornell Medical College, New York, NY, United States.
Insights
Myofascial flap (MFF) closure significantly reduces complications after complex tethered cord release (TCR) surgery in pediatric patients compared to primary wound closure. This plastic surgery technique offers a safer alternative for managing tethered cord syndrome.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Tethered cord syndrome (TCS) involves neurological deficits due to spinal cord adherence.
- Postoperative complications like CSF leaks and infections are common after TCS surgery.
- Comparing wound closure techniques is crucial for improving pediatric TCS outcomes.
Purpose of the Study:
- To compare postoperative complications between primary wound closure and myofascial flap (MFF) closure.
- To evaluate the efficacy of MFF closure with plastic surgery following complex tethered cord release (TCR) in pediatric patients.
Main Methods:
- Retrospective review of 88 pediatric patients undergoing TCR from 2009-2024.
- Comparison of outcomes between primary closure and MFF closure groups.
- Statistical analysis using t-tests, Fisher's exact tests, and Poisson regression to identify risk factors and compare complication rates.
Main Results:
- MFF closure demonstrated significantly fewer total cumulative postoperative complications than primary closure.
- Complex tethered cord etiology and connective tissue disorders were identified as risk factors for complications.
- MFF closure was associated with a 2.3-fold reduction in total cumulative complications (p < 0.05).
Conclusions:
- Myofascial flap (MFF) closure is a viable and effective alternative to conventional wound closure after TCR in pediatric patients.
- MFF closure should be considered for select cases of tethered cord syndrome surgery to minimize complications.
- This approach enhances patient safety and may reduce the need for revision surgeries.
Background:
Tethered cord syndrome encompasses a range of neurological deficits resulting from the spinal cord, filum terminale, or nerve roots adhering to the surrounding tissue within the spinal canal. Postoperative complications, such as cerebrospinal fluid leaks or infections, are not uncommon and increase the risk of morbidity and the need for additional surgeries. This study aimed to compare postoperative complications in pediatric patients who received primary wound closure to those who underwent myofascial flap (MFF) closure with plastic surgery following complex tethered cord release (TCR).
Methods:
We conducted a retrospective review of all pediatric patients who underwent TCR surgery at New York-Presbyterian Weill Cornell Medical Center from 2009 to 2024. Data collected included patient demographics, comorbidities, tethered cord etiologies, surgical approaches, and postoperative outcomes. Student's t-tests, Fisher's exact tests, and backward stepwise Poisson regression were used to compare outcomes between closure techniques and to identify risk factors for postoperative complications.
Results:
Of the 88 patients with complex tethered cords, MFF closure resulted in significantly fewer total cumulative complications than primary closure. Stepwise Poisson regression identified complex tethered cord etiology and connective tissue disorders as significant risk factors for postoperative complications, with incidence rate ratios of 2.3 and 2.0, respectively. In contrast, MFF closure was associated with a 2.3-fold reduction in total cumulative complications (p < 0.05).
Conclusion:
MFF closure is a viable alternative to conventional wound closure after TCR in the pediatric population and should be considered in select cases of tethered cord syndrome surgery.
