Whittemore Brett A, Swift Dale M, Weprin Bradley E, Duffy Frederick J
Departments of 1 Neurosurgery and.
Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas; and.
J Neurosurg Pediatr. 2017 Mar;19(3):333-338. doi: 10.3171/2016.10.PEDS16259. Epub 2017 Jan 20.
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.
目的 巨大脊髓脊膜膨出缺损以及周围组织质量差使得一些缺损尤其难以一期闭合。本文描述了臀上动脉穿支（SGAP）皮瓣技术用于缺损闭合及长期临床疗效。方法 描述了采用SGAP皮瓣闭合脊髓脊膜膨出的技术。对一组采用该方法进行闭合手术的11例患者进行回顾性病历审查。结果 在1999年至2015年间，共闭合271例脊髓脊膜膨出，其中11例采用SGAP皮瓣闭合。平均缺损大小为5.5×7.2 cm。所有患者均接受了脑室腹腔分流术。无脑脊液感染病例。5例患者出现轻微伤口问题（小的伤口裂开或焦痂形成），愈合情况良好。2例患者发生软组织伤口感染，需要多次修复；1例患者有多种严重发育异常，另1例患者的皮瓣在术后4个月愈合，其下方有较厚的脂肪垫。长期随访中无患者出现明显的手术部位疼痛。结论 SGAP皮瓣技术可利用带血管、含脂肪的全层皮肤实现无张力闭合。它对于闭合大的、复杂的缺损有用，与慢性疼痛无关，且发病率风险与其他复杂的脊髓脊膜膨出闭合技术相当。
