title: Outcomes of tethered cord repair with a layered soft tissue closure.
abstract: BACKGROUND
  Previous studies have demonstrated the benefit of releasing symptomatic tethered cords; however, complications such as seroma, cerebrospinal fluid leak, and infection continue to plague these patients. We propose that composite tissue closure of tethered cord repairs yields superior outcomes and that a collaborative effort between neurosurgery and plastic surgery may result in enhanced structural and functional results.
  
  
  METHODS
  This is a retrospective study comprised of consecutive patients with tethered cord syndrome by 2 neurosurgeons and 2 plastic surgeons between 1994 and 2008 at a single institution. All consecutive patients who underwent tethered cord release by neurosurgery and subsequent composite tissue closure with fascial and musculofascial flaps by plastic surgery were included. Data were collected by retrospective chart review and analyzed using parametric methods.
  
  
  RESULTS
  A total of 86 consecutive patients were included in this study, with follow-up ranged from 12 to 144 months (average follow-up, 29 months). There were no statistical differences in follow-up time, comorbidities, or surgeon when comparing hospital readmission or reoperation. There was no statistical difference in complications when comparing the different flap closures. We had a 1.2% infection rate, a 4.7% readmission rate, and a 3.5% reoperation rate.
  
  
  CONCLUSIONS
  We believe that local soft tissue rearrangement improves the closure by providing an additional layer of vascularized tissue between the skin and the spinal cord. We believe our series represents a significant sample size compared with those previously reported for an experience that achieves multilayered soft tissue closure after tethered cord repair. Our results support the idea that neurosurgeons should consider consultation of plastic surgeons when treating patients with tethered cord syndrome surgically.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Levi
authors.forename: Kristoffer B
authors.initials: KB
authors.lastname: Sugg
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Lien
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kasten
authors.forename: Karin M
authors.initials: KM
authors.lastname: Muraszko
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
authors.forename: Steven R
authors.initials: SR
authors.lastname: Buchman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009436:Neural Tube Defects / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D055815:Young Adult