Gutierrez-Ontalvilla Patricia, Blanco Eva Lopez, Miranda Pablo
Unit of Plastic Pediatric Surgery, University Hospital La Fe, Valencia, Spain.
Unit of Pediatric Neurosurgery, University Hospital La Fe, Valencia, Spain.
Childs Nerv Syst. 2019 Jul;35(7):1219-1222. doi: 10.1007/s00381-018-04030-x. Epub 2019 Jan 4.
Closure of the skin defect in myelomeningocele repair determines the quality of the surgical result. In large myelomeningoceles, the direct closure or by skin undermining may not be possible. In these cases, the skin defect must be closed using flaps to provide a tension-free and successful closure.
In this procedure, after neurosurgical repair and closure of the placode, the defect surgically becomes an ovoid in shape. Then, this defect is closed by transposition of two dorsal intercostal artery perforator propeller flaps. The defect size was > 5 cm in diameter. The localization of the lesion was lumbosacral.
A successful tension-free one-stage closure was obtained, without necrosis. Healing was uneventful without any complications and the coverage remained stable over 9 years with the child growth.
The dorsal intercostal artery perforator propeller flap enables the surgeon to achieve a tension-free defect closure of considerably large myelomeningocele defects. This type of closure provides a durable coverage and a soft tissue padding over the neural tissues that persist with the child growth. The dorsal intercostal artery perforator propeller flap seems to be a useful closure of large myelomeningocele defects.
脊髓脊膜膨出修补术中皮肤缺损的闭合决定了手术结果的质量。在大型脊髓脊膜膨出病例中，可能无法直接缝合或通过皮下潜行分离进行缝合。在这些情况下，必须使用皮瓣来闭合皮肤缺损，以实现无张力且成功的缝合。
在此手术过程中，在神经外科修复并闭合神经基板后，手术造成的缺损呈椭圆形。然后，通过转移两个背肋间动脉穿支推进皮瓣来闭合此缺损。缺损直径大于5厘米。病变位于腰骶部。
成功实现了无张力的一期缝合，无坏死发生。愈合过程顺利，无任何并发症，随着患儿生长，覆盖情况在9年中保持稳定。
背肋间动脉穿支推进皮瓣使外科医生能够对相当大的脊髓脊膜膨出缺损实现无张力的缺损闭合。这种闭合方式能提供持久的覆盖，并在神经组织上方形成软组织衬垫，且随着患儿生长持续存在。背肋间动脉穿支推进皮瓣似乎是闭合大型脊髓脊膜膨出缺损的一种有效方法。
