A new technique for closure of large meningomyelocele defects.
BACKGROUND
Although small meningomyeloceles may be amenable to direct closure by undermining of the surrounding skin, the closure of large meningomyelocele defects is a challenging reconstructive problem.


OBJECTIVE
Here, we present a new surgical procedure for the closure of large meningomyelocele defects.


METHODS
In this procedure, after neurosurgical repair and closure of the placode, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 3 years, this new technique, namely Mutaf triangular closure procedure, was used for the closure of large meningomyelocele defects in 5 patients, aged between 2 days to 6 weeks. The defect size was 10.4 x 7.5 cm on average.


RESULTS
In all patients, a tension-free 1-stage closure was obtained. Except one with a minimal hematoma, all patients healed with no complication. There was no patient with late breakdown of the wound during 2 years of mean follow-up.


CONCLUSIONS
Besides the 2 major advantages of short operative time and minimal blood loss, our technique provides a well-vascularized soft tissue padding over the neural tissues, and no suture line overlies the cord closure. With these advantages, this new technique seems to be a useful and safe solution for closure of large meningomyelocele defects.
Mutaf
Mehmet
M
Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey. doctormutaf@yahoo.com
Bekerecioğlu
Mehmet
M
Erkutlu
Ibrahim
I
Bulut
Omer
O
D002490:Central Nervous System / Q000002:abnormalities*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D009432:Neural Crest / Q000473:pathology*; D019651:Plastic Surgery Procedures; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome