Cehan Alina Roxana, Dorobanțu Dorin Constantin, Tamas Corina Ionela, Cehan Vlad Dimitrie, Tamas Flaviu, Balasa Adrian
Plastic and Reconstructive Surgery, Emergency Clinical County Hospital of Targu Mures, 540136 Targu Mures, Romania.
Plastic and Reconstructive Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania.
Clin Pract. 2024 Sep 29;14(5):2056-2070. doi: 10.3390/clinpract14050162.
(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement flap (VYF); and Limberg flap (LF). (2) Methods: A retrospective observational study was conducted from March 2015 to February 2023, and the inclusion criteria were newborns who underwent lumbosacral MMC within 24 h of birth. (3) Results: Out of 20 cases, 45% underwent DS closure; 25% underwent VY-F closure; 15% underwent LF closure, and 15% ( = 3) underwent combined flap closure. A significant statistical correlation was observed between intracranial hypertension (IH), the need for external ventricular drainage (EVD), and DS closure type. In the DS group, 60% of patients required EVD ( = 0.041), and 90% had IH ( = 0.027). CSF fistula was present in 40% of LF cases and 30% of DS cases, while wound dehiscence was observed in 60% of LF cases and 30% of DS cases. (4) Conclusions: Our study demonstrated that DS was linked to higher rates of complications. The VY-F is the safest method for closing MMC defects.
(1) 背景：神经管缺陷是先天性畸形的常见原因，脊髓脊膜膨出（MMC）是最严重的形式。本研究评估MMC手术闭合后的临床结果及术后相关并发症，重点关注以下三种技术：直接缝合（DS）；VY推进皮瓣（VYF）；以及林伯格皮瓣（LF）。(2) 方法：进行了一项回顾性观察研究，时间跨度为2015年3月至2023年2月，纳入标准为出生后24小时内接受腰骶部MMC手术的新生儿。(3) 结果：20例患者中，45%接受了DS闭合；25%接受了VY - F闭合；15%接受了LF闭合，15%（=3）接受了联合皮瓣闭合。观察到颅内高压（IH）、需要进行脑室外引流（EVD）与DS闭合类型之间存在显著的统计学相关性。在DS组中，60%的患者需要EVD（=0.041），90%有IH（=0.027）。LF组40%的病例和DS组30%的病例存在脑脊液瘘，LF组60%的病例和DS组30%的病例出现伤口裂开。(4) 结论：我们的研究表明，DS与更高的并发症发生率相关。VY - F是闭合MMC缺损最安全的方法。
