From the Division of Plastic Surgery, Department of Surgery, and Division of Pediatric Neurosurgery, Department Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX.
Ann Plast Surg. 2022 Jul 1;89(1):82-88. doi: 10.1097/SAP.0000000000003043. Epub 2021 Dec 6.
Myelomeningoceles are formed by prenatal failure of neural tube closure and can cause hydrocephalus, motor abnormalities, and developmental delay. Although small defects are amenable to primary closure, larger defects often require complex reconstruction. Our goal was to identify factors associated with postoperative soft tissue complications and develop a systematic approach for myelomeningocele closure.
A retrospective review was performed at the Children's Memorial Hermann Hospital from January 2013 to January 2019. Patients were identified using International Classification of Diseases, Ninth Revision/Tenth Revision , codes for myelomeningocele. Cohorts were stratified by reconstruction type and defect location. Primary outcomes were incidence of complications including cerebrospinal fluid leak, superficial and deep infection, and wound dehiscence. In addition, we developed an algorithm to standardize closure approach for patients with myelomeningoceles.
A total of 172 patients with myelomeningocele were identified with 73 patients undergoing postnatal repair. Overall, 72% of defects were >5 cm. Defects were in the lumbar (9%), sacral (8%), and junctional (83%) regions. Overall, 30.1% patients underwent lumbar myofascial repair with 39.7% requiring fasciocutaneous flaps. Larger defects (>5 cm) were more likely to be closed with complex fasciocutaneous flaps (82.8% vs 66.0%, P = 0.11). No significant differences were observed in complication rates.
In this series, patients with larger myelomeningoceles appear to benefit from complex flap closure. We propose a 5-layer closure for patients with myelomeningocele including the routine use of a myofascial layer. Cutaneous closure technique should be tailored based on specific defect characteristics as outlined in our algorithm. This approach streamlines myelomeningocele repair while optimizing outcomes and decreasing downstream complications.
脊膜脊髓膨出是由于神经管闭合的产前失败而形成的，可以导致脑积水、运动异常和发育迟缓。虽然小的缺陷可以通过初次闭合来治疗，但较大的缺陷通常需要复杂的重建。我们的目标是确定与术后软组织并发症相关的因素，并制定一种用于脊膜脊髓膨出闭合的系统方法。
对 2013 年 1 月至 2019 年 1 月在儿童纪念赫尔曼医院进行的回顾性研究。使用国际疾病分类，第九修订版/第十修订版的代码来识别脊膜脊髓膨出的患者。根据重建类型和缺陷位置对队列进行分层。主要结果是并发症的发生率，包括脑脊液漏、浅表和深部感染以及伤口裂开。此外，我们还开发了一种算法，用于规范脊膜脊髓膨出患者的闭合方法。
共确定了 172 例脊膜脊髓膨出患者，其中 73 例患者在产后接受了修复。总体而言，72%的缺陷大于 5 厘米。缺陷位于腰椎（9%）、骶骨（8%）和交界处（83%）。总体而言，30.1%的患者接受了腰筋膜修复，其中 39.7%需要筋膜皮瓣。较大的缺陷（>5 厘米）更有可能通过复杂的筋膜皮瓣闭合（82.8%对 66.0%，P=0.11）。并发症发生率没有显著差异。
在本系列中，较大的脊膜脊髓膨出患者似乎受益于复杂的皮瓣闭合。我们提出了一种用于脊膜脊髓膨出患者的 5 层闭合方法，包括常规使用筋膜层。根据我们的算法中概述的特定缺陷特征，应根据具体情况调整皮肤闭合技术。这种方法简化了脊膜脊髓膨出修复，同时优化了结果并减少了下游并发症。
