Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
University Plastic Surgery/Division of Plastic Surgery at Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA.
J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):533-9. doi: 10.1016/j.bjps.2013.12.050. Epub 2014 Jan 4.
The reconstructive goals for myelodysplastic defects are to provide a multilayered, tension-free and well-vascularized closure to prevent cerebrospinal fluid leakage, wound infection or breakdown and to optimize neurologic outcomes. We reviewed our ten-year experience with myelodysplastic defects and our preferred technique for large defects utilizing paraspinous flaps followed by V-Y crescentic rotation advancement flaps. A retrospective chart review was performed on all myelodysplastic defects closed at the University of Chicago Medicine from 2002 to 2012. Twenty-three patients were treated: eight were closed using V-Y crescentic rotation advancement flaps, eight primarily, two with transposition flaps and five with bilateral latissimus dorsi and gluteus maximus myocutaneous flaps. Patient defect characteristics, reconstructive details, follow up time, and wound complications were analyzed. The primary closure group included eight patients. There was one minor complication and two major complications that required debridement and plastic surgery consultation in this group. The transposition group included two patients and had no wound healing issues. The latissimus and gluteus myocutaneous group included five patients and had one minor wound healing issues. The V-Y crescentic group included eight patients. There were four minor wound breakdowns in the lateral donor sites and one major wound complication involving a CSF leak, meningitis and wound breakdown that required debridement. The groups were stratified by size, <5 cm and >5 cm, and further analyzed. Bilateral V-Y crescentic rotation advancement flap is a useful option when confronted with large myelodysplastic defects. It provides a multilayer, tension-free wound closure and spares the gluteus maximus and latissimus dorsi muscle groups.
修复性手术治疗脊髓脊膜膨出的目标是为了提供一个多层的、无张力的、血运良好的覆盖物，以防止脑脊液漏、伤口感染或破裂，并优化神经学预后。我们回顾了过去 10 年在芝加哥大学医学中心治疗脊髓脊膜膨出的经验，以及我们治疗大型脊髓脊膜膨出的首选技术，即利用脊柱旁皮瓣加 V-Y 月牙形旋转推进皮瓣。对 2002 年至 2012 年期间在芝加哥大学医学中心治疗的所有脊髓脊膜膨出患者进行了病历回顾。共有 23 名患者接受了治疗：8 名患者使用 V-Y 月牙形旋转推进皮瓣一期修复，2 名患者使用皮瓣转移修复，5 名患者使用双侧背阔肌和臀大肌皮瓣修复。分析患者的缺陷特征、重建细节、随访时间和伤口并发症。一期缝合组包括 8 名患者，该组有 1 例轻微并发症和 2 例严重并发症，需要清创和整形外科会诊。皮瓣转移组包括 2 名患者，无伤口愈合问题。背阔肌和臀大肌皮瓣组包括 5 名患者，有 1 例轻微伤口愈合问题。V-Y 月牙形皮瓣组包括 8 名患者，其中 4 例外侧供区出现轻微的伤口裂开，1 例严重并发症，包括脑脊液漏、脑膜炎和伤口裂开，需要清创。按缺陷大小（<5cm 和>5cm）对各组进行分层，并进一步分析。双侧 V-Y 月牙形旋转推进皮瓣是治疗大型脊髓脊膜膨出的有效选择。它提供了一个多层的、无张力的伤口覆盖物，并且可以避免臀大肌和背阔肌的损伤。
