Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

  • Putri, Nandita Melati (Division of Plastic, Reconstructive, and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia) ;
  • Tunjung, Narottama (Division of Plastic, Reconstructive, and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia) ;
  • Sadikin, Patricia Marcellina (Division of Plastic, Reconstructive, and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia)
  • Received : 2020.07.02
  • Accepted : 2021.04.12
  • Published : 2021.05.15
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Abstract

Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap. Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps. Results The median age of the patients at surgery was 10.5 days (range, 1-369 days) and the average defect size was 22.5 cm2 (range, 7.1-55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45-120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects. Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

Keywords

References

  1. Duffy FJ Jr, Weprin BE, Swift DM. A new approach to closure of large lumbosacral myelomeningoceles: the superior gluteal artery perforator flap. Plast Reconstr Surg 2004;114:1864-70. https://doi.org/10.1097/01.PRS.0000142741.11963.10
  2. Watson JC, Tye G, Ward JD. Delayed repair of myelomeningoceles. World Neurosurg 2014;81:428-30. https://doi.org/10.1016/j.wneu.2013.01.022
  3. Oakeshott P, Hunt GM. Long-term outcome in open spina bifida. Br J Gen Pract 2003;53:632-6.
  4. Di Rocco C, Trevisi G, Massimi L. Myelomeningocele: an overview. World Neurosurg 2014;81:294-5. https://doi.org/10.1016/j.wneu.2013.02.042
  5. Caldarelli M, Rocco CD. Myelomeningocele primary repair surgical technique. In: Ozek MM, Cinalli G, Maixner WJ, editors. Spina bifida: management and outcome. Milano: Springer; 2008. p. 143-55.
  6. Musluman AM, Karsidag S, Sucu DO, et al. Clinical outcomes of myelomeningocele defect closure over 10 years. J Clin Neurosci 2012;19:984-90. https://doi.org/10.1016/j.jocn.2011.09.026
  7. Kobraei EM, Ricci JA, Vasconez HC, et al. A comparison of techniques for myelomeningocele defect closure in the neonatal period. Childs Nerv Syst 2014;30:1535-41. https://doi.org/10.1007/s00381-014-2430-7
  8. Cologlu H, Ozkan B, Uysal AC, et al. Bilateral propeller flap closure of large meningomyelocele defects. Ann Plast Surg 2014;73:68-73. https://doi.org/10.1097/SAP.0b013e31826caf5a
  9. Jabaiti S, Al-Zaben KR, Saleh Q, et al. Fasciocutaneous flap reconstruction after repair of meningomyelocele: technique and outcome. Pediatr Neurosurg 2015;50:344-9. https://doi.org/10.1159/000439283
  10. Patel KB, Taghinia AH, Proctor MR, et al. Extradural myelomeningocele reconstruction using local turnover fascial flaps and midline linear skin closure. J Plast Reconstr Aesthet Surg 2012;65:1569-72. https://doi.org/10.1016/j.bjps.2012.03.029
  11. de Weerd L, Weum S, Sjavik K, et al. A new approach in the repair of a myelomeningocele using amnion and a sensate perforator flap. J Plast Reconstr Aesthet Surg 2013;66:860-3. https://doi.org/10.1016/j.bjps.2012.11.020
  12. Hallock GG. Reconstruction of posterior trunk defects. Semin Plast Surg 2011;25:78-85. https://doi.org/10.1055/s-0031-1275174
  13. Behan FC. The Keystone Design Perforator Island Flap in reconstructive surgery. ANZ J Surg 2003;73:112-20. https://doi.org/10.1046/j.1445-2197.2003.02638.x
  14. Gomez OJ, Baron OI, Penarredonda ML. Keystone flap: overcoming paradigms. Plast Reconstr Surg Glob Open 2019;7:e2126. https://doi.org/10.1097/GOX.0000000000002126
  15. Gutman MJ, Goldschlager T, Fahardieh RD, et al. Keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 2011;27:1459-63. https://doi.org/10.1007/s00381-011-1448-3
  16. de Chalain TM, Cohen SR, Burstein FD, et al. Decision making in primary surgical repair of myelomeningoceles. Ann Plast Surg 1995;35:272-8. https://doi.org/10.1097/00000637-199509000-00009
  17. Ozcelik D, Yildiz KH, Is M, et al. Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques). Neurosurg Rev 2005;28:218-25. https://doi.org/10.1007/s10143-004-0357-2
  18. Donaldson C, Murday HK, Gutman MJ, et al. Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 2018;34:733-6. https://doi.org/10.1007/s00381-017-3697-2
  19. Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg 2016;77:332-6. https://doi.org/10.1097/SAP.0000000000000600
  20. Jamjoom H, Alnoman H, Almadani Y. Closure of a large thoracolumbar myelomeningocele using a modified bilateral keystone flap. Plast Reconstr Surg Glob Open 2016;4:e1114. https://doi.org/10.1097/GOX.0000000000001114
  21. Mrad MA, Alharbi A, Mahabbat N, et al. Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects: a case report. Ann Med Surg (Lond) 2020;57:339-42. https://doi.org/10.1016/j.amsu.2020.08.012
  22. Gomez O, Barrera C. Keystone flap: a safe coverage option in the handling of salvage for myelomeningocele. Childs Nerv Syst 2020;36:2765-74. https://doi.org/10.1007/s00381-020-04662-y
  23. Formentin C, de Andrade EJ, Matias LG, et al. Using the keystone design perforator island flap in large myelomeningocele closure. Neurosurg Focus 2019;47:E19.
  24. Hifny MA, Hamdan AR. The keystone island perforator flap in reconstruction of large myelomeningocele defects. Ann Plast Surg 2020;84:575-9. https://doi.org/10.1097/SAP.0000000000002058
  25. Ulusoy MG, Kocer U, Sungur N, et al. Closure of meningomyelocele defects with bilateral modified V-Y advancement flaps. Ann Plast Surg 2005;54:640-4. https://doi.org/10.1097/01.sap.0000162522.77690.71
  26. Sharma MK, Kumar N, Jha MK, et al. Experience with various reconstructive techniques for meningomyelocele defect closure in India. JPRAS Open 2019;21:75-85. https://doi.org/10.1016/j.jpra.2019.07.001
  27. Gursoy K, Ustun GG, Akduman B, et al. Analysis of wound complications of patients with meningomyelocele. Turk J Plast Surg 2020;28:19-24. https://doi.org/10.1177/2292550319880913