Is Unilateral Local Flap Reconstruction Sufficient in Large Myelomeningocele Treatment?

Abstract

Objective: Skin flaps are acceptable methods for surgical treatment of myelomeningocele defects in the neonatal period. Skin flaps (e.g., V-Y advancement, rotation or transposition flaps) are often preferred bilaterally for closure of myelomeningocele defects. This study evaluated the adequacy of an alternative unilateral flap method called ice cream-cone flap in repairing large myelomeningocele defects. Patients and Methods: Fifteen newborns who were operated with ice cream cone flap due to myelomeningocele defect were evaluated retrospectively. Surgical repair was carried out within 1-3 days of birth. The defect sizes were ranging 10 cm x 8 cm to 4 cm x 4 cm diameter with the mean diameter of 7.2 cm x 5.4 cm. This technique is mainly based on the planning of unilateral advancement flap that resembles the shape of the defect. The technique includes additional procedures such as anchoring of a deepithelialized skin tissue to provide redistribution of the wound closure tension to the lateral side of the flap, and transposition of a skin protrusion to shorten the peripheral border length of the wound. Results: Durable, stable soft-tissue coverage of the defect was obtained in all patients. No hematoma, seroma, infection, and flap necrosis were observed during the postoperative follow-up period. Two patients had partial wound dehiscence which was healed with secondary wound healing. Conclusion: Ice cream-cone flap technique is fast, reliable, and easily performed and has the advantage of shorter operative time, less blood loss with minimal wound closure tension.