title: Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair.
abstract: BACKGROUND
  The global prevalence of myelomeningocele has been reported to be 0.8-1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution.
  
  
  METHODS
  Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed.
  
  
  RESULTS
  A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely.
  
  
  CONCLUSIONS
  Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.
authors: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Jung-Hwan
authors: JH
authors: Shim
authors: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Na-Hyun
authors: NH
authors: Hwang
authors: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Eul-Sik
authors: ES
authors: Yoon
authors: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Eun-Sang
authors: ES
authors: Dhong
authors: Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Deok-Woo
authors: DW
authors: Kim
authors: Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea.
authors: Sang-Dae
authors: SD
authors: Kim
keywords: Myelomeningocele; Surgical flap; Wound closure techniques