title: Bilateral propeller flap closure of large meningomyelocele defects.
abstract: BACKGROUND
  Meningomyelocele is a defect of the spinal cord, vertebral spine, and overlying skin and is the most common form of spinal dysraphism. Multiple methods of soft tissue closure for larger myelomeningocele defects have been described, including skin grafting, random fasciocutaneous flaps, skin undermining with relaxing incisions, and musculocutaneous flaps. Most current methods for closure of defects of 8 cm and greater and kyphotic spines usually remains inadequate. In this study, we present our clinical experience with a new surgical procedure, bilateral propeller (BP) flaps based on dorsal intercostal and lumbar artery perforator, for the closure of large thoracolumbar meningomyelocele defects.
  
  
  METHODS
  Between January 2011 and April 2012, 7 newborns (5 males and 2 females) with thoracolumbar large meningomyelocele were included in the study. Six patients had lumbar kyphosis. Myelomeningocele defects with a mean size of 89.3 cm (range, 58.9-136.8) were closed with BP flaps.
  
  
  RESULTS
  All flaps survived; hematoma, seroma, wound dehiscence, flap necrosis, or infection was not observed. No patients required any surgical revisions. The patients had a follow-up of 4 to 16 months with a mean of 10 months, and no long-term complications, including necrosis of flap edges, wound breakdown, or instability, have been apparent in our series.
  
  
  CONCLUSIONS
  We believe that the BP flaps represent a useful tool in the management of soft tissue defects associated with especially kyphotic large thoracolumbar and lumbosacral myelomeningoceles.
authors.affiliation: From the *Medical Faculty, Department of Plastic and Reconstructive Surgery, Baskent University, Adana; †Medical Faculty, Department of Plastic and Reconstructive Surgery, Baskent University, Ankara; and ‡Medical Faculty, Department of Pediatric Surgery, Cukurova University, Adana, Turkey.
authors.forename: Harun
authors.initials: H
authors.lastname: Cöloğlu
authors.forename: Burak
authors.initials: B
authors.lastname: Ozkan
authors.forename: Ahmet Cağr
authors.initials: AC
authors.lastname: Uysal
authors.forename: Ozlem
authors.initials: O
authors.lastname: Cöloğlu
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Borman
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps