CLINICAL OUTCOMES OF LARGE MENINGOMYELOCELE DEFECT REPAIR BY BILATERAL FASCIOCUTANEOUS ROTATION FLAPS WITH PERFORATORS.

Mustafa Kürşat Evrenos, Haldun Onuralp Kamburoğlu, Mehmet Seçer, Kadir Çınar, Mehmet Dadacı, Bilsev İnce

Özet


ABSTRACT
Background:
Neural tube defects occur approximately one in 1000 live births/year in USA. Myelomeningocele (MMC) is the most common and severe form of spina bifida aperta. In this study, we present a surgical modification of the bilateral fasciocutaneous rotation and advancement flap technique in MMC patients.
Patients and Methods:
A retrospective evaluation of 24 patients (12 male, 12 female) with myelomeningocele was performed and the relationship between hydrocephalus, neurological status and the level and size of the myelomeningocele was recorded according to type of defect closure. We used bilateral perforator based fasciocutaneous rotation and advancement flaps for defects larger than 3 cm width or if there was presence of prominent kyphosis with any defect size.


Results:
Follow-up period was between 8 days to 2 years. One patient died at 8th day after surgery because of sepsis related to aspiration pneumonia. One patient had CSF collection under repair zone. In another patient, CSF leakage was observed through the repaired incision on the 9th day of surgery. 3 patients had minimal wound dehiscence at distal edge of suture line.
Conclusion:
In this study, 24 patients were treated with this perforator based technique by preserving at least one perforator vessel on each side. Reconstruction of meningomyelocele defects with paraspinal fasciocutaneous flaps is still one of the best choice for closing moderate-to-large defects without using a skin graft and safety of the flaps increase by preserving the perforators.
Keywords: Myelomeningocele, Meningomyelocele, Fasciocutaneous Flap, Perforator Flap
ÖZET
Amaç:
Nöral tüp defektlerinin Amerika Birleşik Devletleri’nde görülme sıklığı yılda 1/1000’dir. Myelomeningosel, Spina Bifida Aperta deformitesinin yaşamla bağdaşan en sık görülen ve en ağır formudur. Bu çalışmada myelomeningosel hastalarında bir cerrahi tekniğin modifikasyonunu sunuyoruz.
Gereç / Yöntem:
Retrospektif olarak 24 myelomeningosel hastası (12 Erkek, 12 kız) analiz edildi. Ayrıca hastaların eşlik eden hidrosefali gibi deformiteleri, nörolojik durumları, defekt seviyesi ve boyutu ile defekt onarım yöntemleri değerlendirildi. Defekt genişliğinin 3 cm.’den küçük olduğu durumlarda primer onarım yapıldı. Defektin 3 cm.’den büyük olduğu ya da kifoz deformitesinin eşlik ettiği durumlarda ise; her bir tarafta en az bir perforatörün korunduğu bilateral fasyokutan rotasyon flebi ile rekonstrüksiyon gerçekleştirildi.
Bulgular:
Takip süresi 8 gün ile 2 yıl arasında gerçekleşti. Primer onarım yapılan hastalarda komplikasyon gözlenmedi. Bir hasta postoperatif 8. Günde aspirasyon pnömonisine sekonder sepsis nedeniyle kaybedildi. Bir hastada onarım bölgesi altında beyin omurilik sıvısı birikimi saptandı. Bir hastada ise postoperatif 9. günde onarım hattından beyin omurilik sıvısı sızıntısı gözlendi. 3 hastada onarım hattı distalinde minimal dehissans gözlendi.
Sonuç:
Bu çalışmada 24 hastada defekt rekonstrüksiyonu, her bir tarafta en az bir perforatörün korunuğu bilateral fasyokutan rotasyon flebi ile gerçekleştirildi. Kanımızca paraspinal fasyokutan rotasyon flepleri, geniş myelomeningosel defektlerinin onarımında greft kullanımına gerek bırakmayan en uygun rekonstrüksiyon seçeneğidir.
Anahtar kelimeler:
Meningomyelosel, Myelomeningosel, Fasyokutan Flep, Perforatör Flep.

Tam Metin:

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Türk Plastik Rekonstrüktif ve Estetik Cerrahi Dergisi (Turk J Plast Surg),
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