Closure of Large Myelomeningocele Defects Using the O-S Flap Technique.

BACKGROUND: Meningomyelocele is a kind of spina bifida. In this deformity, the spinal canal and the back bone is open. This type of birth defect is also called a neural tube defect. There are many and different methods on the closure of large meningomyelocele defects. Although small meningomyeloceles may be agreeable to direct or primary closure with the local surrounding skin, the closure of large meningomyelocele skin defects needs more complex methods.

PURPOSE: The author presented a different surgical procedure for the closure of large meningomyelocele defects.

MATERIAL AND METHODS: The authors presented 9 neonates treated with an O-S (O is the shape of the defect, and S is the final scar shape) advancement procedure. After neurosurgical repair of the placode performed, the skin defect is closed with the O-S flap. This flap method is used for the closure of large meningomyelocele defects in 8 patients, aged between 4 days to 3 months. The defect size was 9.0 to 12.0 cm to 5.3 to 8.5 cm on an average.

RESULTS: Mean follow-up was 9.25 months (range: 2-19 months). In all patients, there was no any flap ischemia, and the tension-free 1-stage closure was ensured. All patients healed without any complication. In one patient, cerebrospinal fluid leakage was observed. Revision surgery was done for this patient. No wound dehiscence was seen at follow-up period.

CONCLUSIONS: The major advantages of this technique are: defects can be closed with only 2 incisions, short operative time, and there is no additional muscle transfer. Our suggested technique also provides a well-vascularized cutaneous tissue covering over the neural tissues. This suggested new technique seems to be a safe and practical solution for closure of the large meningomyelocele defects.