Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps.
BACKGROUND
Although several different methods were described in the literature, closure of large meningomyelocele defects presents a challenging problem. Wound dehiscence may lead to devastating complications. In this paper, the efficacy of the bilateral modified V-Y advancement flap procedure was investigated in terms of simplicity, donor-site morbidity, and reliability.


METHODS
The authors presented 10 neonates treated with a modified subcutaneous advancement procedure. Unlike the typical V-Y advancement techniques, the apical extensions of the "V" flaps were elevated based on the paraspinous perforators. A standard closure algorithm was not followed, as the well-vascularized apical extensions facilitated intraoperative decision making for the most appropriate adaptation pattern, depending on the size, shape, and localization of the defect. As well as that, transposition of these apical flaps to the defect site was further supported by the advancement of the V-Y flaps to decrease the tension along the closure.


RESULTS
Mean follow-up period was 13.6 months (range 3-37 months), and no complications that might be attributable to the operative procedure were observed.


CONCLUSIONS
Utilization of bilateral modified V-Y flaps for the closure of large meningomyelocele defects is a simple and effective procedure. Main advantages of the method described in this paper may be listed as follows: simplicity, reliability due to coverage of the defect with well-vascularized flaps, minimal bleeding, decreased operative time, and no donor-site morbidity.
Ulusoy
M Gürhan
MG
Department of Plastic and Reconstructive Surgery, Ankara Training and Research Hospital, Ankara, Turkey. gurhanulusoy@yahoo.com
Koçer
Uğur
U
Sungur
Nezih
N
Karaaslan
Onder
O
Kankaya
Yüksel
Y
Ozdemir
Ragp
R
Gümüş
Murat
M
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome