Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps.
OBJECTIVE
Myelomeningocele (MMC) is the most complex congenital malformation of the CNS that is compatible with life. Different closure techniques are available for defect reconstruction, but wound healing and tension-free closure of the skin in the midline remain major considerations in large MMCs. In this study, the authors used bilateral proximally based latissimus dorsi (LD) skin island muscle pedicle flaps for closure of large thoracolumbar MMC defects.


METHODS
Twenty infants with very large thoracolumbar MMCs were enrolled in the study. The mean of age of the patients was 4.1 +/- 2.3 months. The width of the MMC was 6 +/- 1.2 cm. At operation, 2 triangular V-Y flaps were designed on each side of the defect; the tip of the triangle was extended to the posterior axillary line. The LD flaps based on the thoracodorsal arteries were elevated bilaterally and advanced toward the midline with moderate tension and sutured together. Postoperatively, infants were positioned prone for 7 days and discharged on the 8th day after the operation. They were followed every 2 weeks for evaluation of wound healing.


RESULTS
The wounds healed without any major complication. There was no dehiscence in the postoperative period.


CONCLUSIONS
The authors recommended bilateral superiorly based LD skin flaps as an effective method for closure of large thoracolumbar MMC defects. Neural tube defects are among the most common of all human birth defects.
Hosseinpour
Mehrdad
M
Trauma Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Isfahan, Iran.
Forghani
Siamak
S