title: [Use of expanders in surgical treatment of kyphosis in patients with myelomeningocele].
abstract: BACKGROUND
  Numerous surgical techniques of instrumentation have been described in surgical management of kyphosis in children with myelomeningocele. However, complications related to surgical technique or the soft tissue reconstruction can exist. Tissue expansion is a technique that can be used before spine surgery with damaged skin.
  
  
  METHODS
  We studied 11 patients with myelomeningocele and kyphosis. All had dural sac closure in neonatal stage as well as thoracic or upper lumbar lesion with severe neurologic deficit. Patients were evaluated by a plastic surgeon that placed a soft tissue expander, as the first stage of reconstruction. Kyphectomy, instrumentation, posterior fusion, expander removal and wound closure were done as a second stage.
  
  
  RESULTS
  Fifteen tissue expanders were placed in 11 patients; 4 patients had 2 expanders and 7 patients had one. All the expanders were placed in the back, 9 expanders were placed in thoracic region and 6 in the lumbar region with an average of 17 weeks in the body. No complications were detected in the postoperative period of the tissue expansion. Neurologic deficit was thoracic in 9 patients and upper lumbar in 2 patients; we used for instrumentation ACM plates in 6 patients, SSI with Luque rods in 2 patients, crossed nails in 1 patient, 3.5 DCP in one patient, and we did not use instrumentation in one patient. Four patients (36.3%) had complications related to the kyphectomy and instrumentation in the postoperative period.
  
  
  CONCLUSIONS
  Use of tissue expanders before the surgical management of kyphosis in myelomeningocele is a good option to avoid complications of soft tissue coverage, evaluation of patients and indications for expanders must be done by a plastic surgeon.
authors.affiliation: Hospital Shriners para Niños, Ciudad de México. drgomch@hotmail.com
authors.forename: Jorge
authors.initials: J
authors.lastname: Gómez Chavarría
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cardoso Monterrubio
authors.forename: Enrique
authors.initials: E
authors.lastname: Garavito Salazar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D012189:Retrospective Studies; D015626:Tissue Expansion; D015625:Tissue Expansion Devices; D055815:Young Adult