Reconstructive strategy for meningomyelocele surgery defects
Dr. Salesh Kumar Soni, Dr. Manav P Suri, Dr. Brijendrasinh K Rana
The global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. The prevalence and regular call of defect coverage for the same in our institute lead us to study further for the same. The aim of our study was to collect the data of meningomylocele defects encountered and methods of its coverage with various flap mentioned in the books and to do modification in it if required for better result as per our experience. From January 2018 to May 2019, 25 patients with myelomeningocele defects underwent repair at our institution. Of these patients, twenty were male and five were female, with a mean age of 35 days. Fifteen patients (60%) underwent direct repair (Primary Closure), four patients (16%) underwent a reading man flap, two patient (8%) underwent bilobed flap and four patents (16%) underwent transposition flap procedure to cover the myelomeningocele defect. Of total 25 cases 1 case had complication of epidermal loss at distal most end of flap. It was managed conservatively and 1 case had infection in post-operative period which was also managed conservatively by daily dressing. Thus the overall complication rate in our study is 10%. Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local fasciocutaneous flaps may be used to cover the defect with modification to the axis of flap for better coverage and smaller requirement of STSG. Complete coverage can be done without STSG using reading man flap. Results are better with the use of modified local fasciocutaneous flap with no major downside.