Algan Mehmet Fatih, Firat Cemal, Bekircan Kagan, Kilinc Hidir, Onal Selami Cagatay
Malatya Turgut Ozal University, Malatya Education and Research Hospital, Department of Plastic Surgery, Malatya, Turkey.
Turk Neurosurg. 2021;31(6):944-951. doi: 10.5137/1019-5149.JTN.32924-20.3.
To evaluate fasciocutaneous flaps used for reconstruction of meningomyelocele defects in our clinic and to suggest an algorithm for flap selection.
A retrospective analysis of 45 patients with meningomyelocele, who underwent repair with fasciocutaneous flaps, was carried out. Preoperative and postoperative photos were analyzed. The defect areas were measured by Adobe Photoshop CC. Limberg flap, bilateral Limberg flaps, bilateral bipedicled advancement flaps, bilobed flap and reading man flap were performed.
Wound dehiscence and partial necrosis occurred in 8 patients. All wounds were managed conservatively and healed successfully. No other complications were observed. The mean defect size for all patients was 36 cm². The mean defect size was 45.3 cm² in bilateral bipedicled flaps cases; 33.5 cm² in bilateral Limberg flaps cases; and 19.6 cm² in the unilateral Limberg flap cases. According to the algorithm, a unilateral Limberg flap or bilobed flap or reading man flap can be used for the defects smaller than 25 cm²; bilateral Limberg flaps can be used for the defects between 25 and 35 cm²; and bilateral bipedicled advancement flaps can be used for the defects larger than 35 cm².
Fasciocutaneous flaps can be preferred in meningomyelocele defect reconstruction due to the easy planning of flaps, easy and fast flap elevation, and low complication rates due to their reliable circulation. The measurement of the defect area allows this algorithm selecting a flap in a more practical way.
评估在我们诊所用于修复脊髓脊膜膨出缺损的筋膜皮瓣，并提出一种皮瓣选择算法。
对45例行筋膜皮瓣修复的脊髓脊膜膨出患者进行回顾性分析。分析术前和术后照片。缺损面积通过Adobe Photoshop CC测量。采用Limberg皮瓣、双侧Limberg皮瓣、双侧双蒂推进皮瓣、双叶皮瓣和里丁曼皮瓣。
8例患者出现伤口裂开和部分坏死。所有伤口均经保守处理并成功愈合。未观察到其他并发症。所有患者的平均缺损面积为36平方厘米。双侧双蒂皮瓣病例的平均缺损面积为45.3平方厘米；双侧Limberg皮瓣病例为33.5平方厘米；单侧Limberg皮瓣病例为19.6平方厘米。根据该算法，缺损面积小于25平方厘米的可采用单侧Limberg皮瓣、双叶皮瓣或里丁曼皮瓣；缺损面积在25至35平方厘米之间的可采用双侧Limberg皮瓣；缺损面积大于35平方厘米的可采用双侧双蒂推进皮瓣。
筋膜皮瓣因其皮瓣设计简单、皮瓣掀起容易快速且血运可靠并发症发生率低，可优先用于脊髓脊膜膨出缺损修复。缺损面积的测量使该算法能更实用地选择皮瓣。
