Billings Plastic Surgery Clinic, 2510 17th Street West, Billings MT 59102, USA.
J Plast Reconstr Aesthet Surg. 2012 May;65(5):572-7. doi: 10.1016/j.bjps.2011.10.014. Epub 2012 Feb 5.
The goals of this study were to review the outcome of the surgical procedure and hospitalization associated with meningomyelocele repair, and to examine the results of different closure strategies.
Eighty-three consecutive patients having surgery for meningomyelocele over a ten year period form the basis of this study. Thirty-two closures with a mean defect size preoperatively of 11.5 cm(2) were performed by the neurosurgeon (ADP), and fifty-one closures with a mean defect size of 28.4 cm(2) by the plastic surgeon (MFA).
Defects up to 12 cm(2) were closed with local advancement fasciocutaneous flaps. As defect size increased, latissimus muscle flaps were added in 30 (36%) and gluteus muscle in 16 (19%). In recent years, 18 patients (21.6%) with a mean defect of 29 cm(2) were treated with overlapping of deepithelialized fasciocutaneous flaps to add an additional layer of coverage to the dural closure. There were 9 major complications, 6 requiring reoperation. There were 10 minor wound failures managed conservatively. Mean hospital stay was 24.2 days. Re-operation increased length of stay to 45 days (p < 0.0001). Minor wound problems added 6 days to mean hospital stay. Wound failure did not correlate with either defect size or closure technique. Thoracic location was associated with increased wound failure (p < 0.05). Use of a shunt did not increase morbidity. All closures remained durable after discharge.
Location in the thoracic area predicts major wound failure and need for reoperation. Wound complications significantly increase hospital stay. The use of a variety of techniques to achieve multi-layered closures leads to durable coverage for defects of all sizes.
本研究的目的是回顾脑脊膜膨出修复手术的结果和住院情况，并检查不同的闭合策略的结果。
在十年期间，共有 83 例连续接受脑脊膜膨出手术的患者纳入本研究。神经外科医生（ADP）完成了 32 例，平均术前缺损大小为 11.5cm²的闭合，整形外科医生（MFA）完成了 51 例，平均缺损大小为 28.4cm²的闭合。
缺损大小达 12cm²的病例采用局部推进筋膜皮瓣闭合。随着缺损的增大，30 例（36%）加用了背阔肌肌皮瓣，16 例（19%）加用了臀大肌肌皮瓣。近年来，18 例（21.6%）平均缺损为 29cm²的患者采用去表皮化筋膜皮瓣重叠，为硬脑膜闭合增加额外的覆盖层。有 9 例出现重大并发症，其中 6 例需要再次手术。10 例小面积伤口失败采用保守治疗。平均住院时间为 24.2 天。再次手术使住院时间延长至 45 天（p<0.0001）。小面积伤口问题使平均住院时间增加了 6 天。伤口失败与缺损大小或闭合技术无关。胸段位置与增加的伤口失败相关（p<0.05）。使用分流管不会增加发病率。所有的闭合在出院后仍然持久。
胸段位置预测了大面积伤口失败和需要再次手术的情况。伤口并发症显著增加了住院时间。使用多种技术实现多层闭合，可使各种大小的缺损得到持久的覆盖。
