A new twist to the myocutaneous turnover flap for closure of a spinal defect

We have described the deepithelialized myocutaneous turnover of a gluteus maximus island flap based on the superior gluteal vessels used for closure of an acquired midline defect of the lower back complicated by cerebrospinal fluid fistula. Cerebrospinal fluid fistula, although a rare complication of an acquired midline back defect, further adds to the reconstructive challenge of such a wound. As this case illustrates, cerebrospinal fluid fistula can have serious and potentially life-threatening implications and so demands rapid surgical intervention. Dural patching with fascia lata graft having already failed, reconstruction was achieved using a well vascularized deepithelialized cutaneous patch on a gluteus maximus island turnover flap. The technique of deepithelializing a skin island for dural repair could be applied to any myocutaneous flap used in reconstruction of a midline back defect complicated by cerebrospinal fluid leak. This provides a method of dural repair and reconstruction of the defect in one step and obviates the need for cerebrospinal fluid diversion.