title: Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles.
abstract: OBJECTIVE Large myelomeningocele defects and poor surrounding tissue quality make some defects particularly difficult to close primarily. This paper describes the superior gluteal artery perforator (SGAP) flap technique for defect closure and long-term clinical outcomes. METHODS The technique for closing a myelomeningocele with an SGAP flap is described. A retrospective chart review was performed on a cohort of 11 patients who underwent closure in this manner. RESULTS Between 1999 and 2015, 271 myelomeningoceles were closed, 11 of which were SGAP flap closures. The mean defect size was 5.5 × 7.2 cm. All patients underwent ventriculoperitoneal shunting. There were no cases of CSF infection. Five patients had minor wound issues (small dehiscence or eschar formation) that healed satisfactorily. Two patients had soft-tissue wound infections and required multiple revisions; one patient had multiple severe developmental abnormalities, and the other patient's flap had healed with a thick underlying fat pad 4 months postoperatively. No patients had significant surgical site pain on long-term follow-up. CONCLUSIONS The SGAP flap technique achieves tension-free closure with vascularized, fat-bearing full-thickness skin. It is useful for closure of large, complex defects, is not associated with chronic pain, and carries a morbidity risk that is comparable to other complex myelomeningocele closure techniques.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Whittemore
authors.affiliation: Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas; and.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Swift
authors.affiliation: Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas; and.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Weprin
authors.affiliation: Department of Plastic Surgery, Medical City Hospital, Dallas, Texas.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Duffy
mesh_terms: D002081:Buttocks / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008591:Meningomyelocele / Q000000981:diagnostic imaging* / Q000601:surgery*; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors
keywords: SGAP = superior gluteal artery perforator; VAC = vacuum-assisted closure; VP = ventriculoperitoneal; myelomeningocele closure; spina bifida; spine; superior gluteal artery perforator flap; surgical technique