title: Comparison of the Ramirez technique for the closure of large open myelomeningocele defects with alternative methods.
abstract: BACKGROUND
  To compare the Ramirez technique for the operative closure of large open myelomeningocele defects with conventional closure techniques in newborns. We hypothesized that the immediate surgical treatment with the Ramirez technique is superior to prior used operative techniques.
  
  
  METHODS
  From 2003 to 2010, 23 children (8 female, 15 male) underwent closure of large open myelomeningocele defects using the Ramirez technique (group A), while from 1993 to 2002, 23 children (6 female, 17 male) underwent conventional closure techniques (group B). All children were included in the retrospective analysis with a mean follow-up period of 3.4 years.
  
  
  RESULTS
  Perioperative variables were similar in both groups (P = ns). There were no hospital deaths in both groups. The operation time was significantly higher in group A (228.7 ± 76.8 versus 157.8 ± 70.3 min, P = 0.003). Mean length of hospital stay was significantly lower in group A (30.7 ± 16.4 days versus 52.0 ± 38.5; P = 0.02). Postoperative complication rate was significantly lower in group A (P = 0.01). Beyond postoperative day 10, liquor fluid leakage was significantly lower in group A (P = 0.05). During follow-up, there were no complications in group A. In group B, 2 children developed liquor fistulas.
  
  
  CONCLUSIONS
  The Ramirez technique allows efficient and safe closure of large open myelomeningocele defects and reduces incidence of postoperative liquor fistulae. The increased operation time and surgical efforts seem to be justified. Treatment of large myelomeningocele defects requires an interdisciplinary team including paediatrician-neonatologists, neurosurgeons and plastic surgeons.
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. Electronic address: amir.bigdeli@bgu-ludwigshafen.de.
authors.forename: Amir K
authors.initials: AK
authors.lastname: Bigdeli
authors.affiliation: Department of Trauma and Orthopedic Surgery, Paracelcus Medical University, Nürnberg, Germany.
authors.forename: Joerg P
authors.initials: JP
authors.lastname: Himmler
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Ilker Y
authors.initials: IY
authors.lastname: Eyüpoglu
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.affiliation: Department of Paediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Almut
authors.initials: A
authors.lastname: Hirsch
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Volker J
authors.initials: VJ
authors.lastname: Schmidt
authors.affiliation: Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Justus P
authors.initials: JP
authors.lastname: Beier
authors.affiliation: Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Four-flap-compound-technique; Myelomeningocele; Ramirez; Ramirez technique