Chalhoub Rawad, Makkawi Kareem, Chrabieh Edwin, El Hachem Tarek, Hajjar Marwan, Ibrahim Amir
From the Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Plast Reconstr Surg Glob Open. 2025 Jul 9;13(7):e6945. doi: 10.1097/GOX.0000000000006945. eCollection 2025 Jul.
This case report describes the management of a 6-year-old girl with a cerebrospinal fluid (CSF) leak following trauma after a previous myelomeningocele repair. The patient initially presented with a recurrent CSF leak, wound dehiscence, and infection. In an attempt to close the pseudomeningocele, a bilateral latissimus dorsi musculocutaneous flap procedure was performed. Despite this intervention, she developed a persistent CSF leak, which led to infection and dehiscence of the wound at the midline. She then required secondary repair of the dural defect and insertion of a lumbar drain, while the plastic surgery team applied an Integra dermal regeneration template combined with vacuum-assisted closure (VAC) therapy. One week later, the wound showed no signs of infection, and the VAC was removed. One week later, for optimal lumbar drainage, a ventriculoperitoneal shunt was inserted. The patient's postoperative course was complicated by fever and ileus, both of which resolved with bowel rest and antibiotics. The patient was discharged in stable condition with no further leakage. On follow-up 4 months later, the patient reported no issues. This case illustrated the successful use of a multidisciplinary approach in managing CSF leaks following myelomeningocele repair by using Integra combined with VAC therapy and a ventriculoperitoneal shunt for optimal wound closure and healing.
本病例报告描述了一名6岁女孩在既往脊髓脊膜膨出修补术后创伤后发生脑脊液（CSF）漏的治疗情况。患者最初表现为复发性脑脊液漏、伤口裂开和感染。为了闭合假性脑脊膜膨出，进行了双侧背阔肌肌皮瓣手术。尽管进行了这种干预，她仍出现持续性脑脊液漏，导致中线伤口感染和裂开。然后她需要对硬脑膜缺损进行二次修复并插入腰大池引流管，同时整形手术团队应用了Integra真皮再生模板联合负压封闭引流（VAC）疗法。一周后，伤口没有感染迹象，VAC被移除。又过了一周，为了实现最佳的腰大池引流，插入了脑室腹腔分流管。患者术后病程因发热和肠梗阻而复杂化，通过肠道休息和使用抗生素后两者均得到缓解。患者出院时情况稳定，没有进一步渗漏。4个月后的随访中，患者报告无任何问题。本病例说明了通过使用Integra联合VAC疗法以及脑室腹腔分流管以实现最佳伤口闭合和愈合，在脊髓脊膜膨出修补术后脑脊液漏的管理中成功采用了多学科方法。
