Bilateral Fasciocutaneous Sliding V-Y Advancement Flap for Meningomyelocele Defect

척수수막류 결손 재건을 위한 양측 V-Y 전진피판술

  • Shin, Jong-Weon (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Oh, Deuk-Young (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Lee, Jung-Ho (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Moon, Suk-Ho (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Seo, Je-Won (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Rhie, Jong-Won (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Ahn, Sang-Tae (Department of Plastic Surgery, The Catholic University of Korea College of Medicine)
  • 신종원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 오득영 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 이중호 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 문석호 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 서제원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 이종원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 안상태 (가톨릭대학교 의과대학 성형외과학교실)
  • Received : 2010.05.04
  • Accepted : 2010.07.19
  • Published : 2010.11.10

Abstract

Purpose: Meningomyelocele is the most common type of neural tube defect disease. Early surgical treatment is recommended to prevent central nervous system infection. Several reconstruction methods were reported previously regarding surgical wound defect closure following meningomyelocele excision. In this article, we report two successful patients using the bilateral fasciocutaneous sliding V-Y advancement flap as a covering for meningomyelocele defects. Methods: Two patients with meningomyelocele were evaluated. Both patients were male and received their operations on the 1st and 4th day of life. After neurosurgeons completed their part of the operation, the V-Y advancement flap was used to close the defect. Initially a bilateral V-shape incision design was made on the skin such that the base of the V-flap measures identical to the size of the wound defect. An incision was made down to the fascia in order to allow the V-flaps to slide into the defect. Subfascial dissection was performed up to 1/3 to 1/4 the length of the V-flap from the wound while minimizing injury to the perforating vessels. Results: Both patients were treated successfully and there was no evidence of complication in 2 months follow up. Conclusion: Several reconstruction methods such as local flaps, skin graft and myocutaneous flaps were reported regarding meningomyelocele surgical wound defect closure. Bilateral fasciocutaneous sliding V-Y advancement flap is an easy method without involving the underlying muscles or a secondary skin graft in a short operation time. Therefore we recommend this treatment option for reconstruction of the wound defect following meningomyelocele excision.

Keywords

References

  1. Bowman RM, Boshnjaku V, McLone DG: The changing incidence of myelomeningocele and its impact on pediatric neurosurgery: a review from the Children's Memorial Hospital. Childs Nerv Syst 25: 801, 2009 https://doi.org/10.1007/s00381-009-0865-z
  2. Ulusoy MG, Kocer U, Sungur N, Karaaslan O, Kankaya Y, Ozdemir R, Gumus M: Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps. Ann Plast Surg 54: 640, 2005 https://doi.org/10.1097/01.sap.0000162522.77690.71
  3. Smyth BT, Piggot J, Forsythe WI, Merrett JD: A controlled trial of immediate and delayed closure of myelomeningocele. J Bone Joint Surg Br 56: 297, 1974 https://doi.org/10.2106/00004623-197456020-00007
  4. Komuro Y, Yanai A, Koga Y, Seno H, Inoue M: Bilateral modified V-Y advancement flaps for closing meningomyelocele defects. Ann Plast Surg 57: 195, 2006 https://doi.org/10.1097/01.sap.0000215281.05153.0c
  5. Luce EA, Walsh J: Wound closure of the myelomeningocele defect. Plast Reconstr Surg 75: 389, 1985 https://doi.org/10.1097/00006534-198503000-00015
  6. Luce EA, Stigers SW, Vandenbrink KD, Walsh JW: Split thickness skin grafting of the myelomeningocele defects. a subset at risk for late ulceration. Plast Reconstr Surg 87: 116, 1991 https://doi.org/10.1097/00006534-199101000-00018
  7. Park C, Park BY: Fasciocutaneous V-Y advancement flap for repair of sacral defects. Ann Plast Surg 21: 23, 1988 https://doi.org/10.1097/00000637-198807000-00004
  8. Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T: Distal perforator-based fasciocutaneous V-Y flap for treatment of sacral pressure ulcers. Plast Reconstr Surg 114: 906, 2004 https://doi.org/10.1097/01.PRS.0000133167.81269.40