title: Local and regional flap closure in myelomeningocele repair: a 15-year review.
abstract: OBJECTIVE
  A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size.
  
  
  METHODS
  We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect.
  
  
  RESULTS
  Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis.
  
  
  CONCLUSIONS
  Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair.
authors.affiliation: Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5338, USA.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Lien
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
authors.forename: Hugh J L
authors.initials: HJ
authors.lastname: Garton
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kasten
authors.forename: Karin M
authors.initials: KM
authors.lastname: Muraszko
authors.forename: Steven R
authors.initials: SR
authors.lastname: Buchman
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects