title: Negative pressure wound therapy for a large skin ulcer following repair of huge myeloschisis with kyphosis in a newborn.
abstract: BACKGROUND
  In surgery of repair for spina bifida, various skin plastic techniques are sometimes necessary due to large skin defect or subsequent ulcers in cases when approximation on the midline is difficult.
  
  
  METHODS
  A baby was born with a large skin defect due to huge lumbar myeloschisis and kyphosis, which was repaired 2 days after birth using Limberg's skin flap at the peak of kyphosis. Skin ischemia around the tip of the flap gradually enlarged and resulted in a large skin ulcer. We performed negative pressure wound therapy (NPWT) using a Vacuum Assisted Closure (V.A.C.®) therapy system for 4 weeks which shrank the ulcer remarkably. Subsequently, a pedicle skin flap without graft was performed to cover the rest of the ulcer, which adapted well without CSF leakage postoperatively.
  
  
  CONCLUSIONS
  A combination treatment of NPWT and skin plastic surgery was successfully performed for a very young infant with spina bifida. NPWT could be another useful option for the treatment of ulcer following spina bifida repair surgery, though surgeons should carefully confirm that there is no CSF leakage before and during the procedure.
authors.affiliation: Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan, katano@med.nagoya-cu.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Toriyama
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nishikawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
authors.forename: Akimichi
authors.initials: A
authors.lastname: Morita
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kamei
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamada
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007738:Kyphosis / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery*; D016135:Spinal Dysraphism / Q000601:surgery*; D013524:Surgical Flaps