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

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 OZET Amac: Noral tup defektlerinin Amerika Birlesik Devletleri’nde gorulme sikligi yilda 1/1000’dir. Myelomeningosel, Spina Bifida Aperta deformitesinin yasamla bagdasan en sik gorulen ve en agir formudur. Bu calismada myelomeningosel hastalarinda bir cerrahi teknigin modifikasyonunu sunuyoruz. Gerec / Yontem: Retrospektif olarak 24 myelomeningosel hastasi (12 Erkek, 12 kiz) analiz edildi. Ayrica hastalarin eslik eden hidrosefali gibi deformiteleri, norolojik durumlari, defekt seviyesi ve boyutu ile defekt onarim yontemleri degerlendirildi. Defekt genisliginin 3 cm.’den kucuk oldugu durumlarda primer onarim yapildi. Defektin 3 cm.’den buyuk oldugu ya da kifoz deformitesinin eslik ettigi durumlarda ise; her bir tarafta en az bir perforatorun korundugu bilateral fasyokutan rotasyon flebi ile rekonstruksiyon gerceklestirildi. Bulgular: Takip suresi 8 gun ile 2 yil arasinda gerceklesti. Primer onarim yapilan hastalarda komplikasyon gozlenmedi. Bir hasta postoperatif 8. Gunde aspirasyon pnomonisine sekonder sepsis nedeniyle kaybedildi. Bir hastada onarim bolgesi altinda beyin omurilik sivisi birikimi saptandi. Bir hastada ise postoperatif 9. gunde onarim hattindan beyin omurilik sivisi sizintisi gozlendi. 3 hastada onarim hatti distalinde minimal dehissans gozlendi. Sonuc: Bu calismada 24 hastada defekt rekonstruksiyonu, her bir tarafta en az bir perforatorun korunugu bilateral fasyokutan rotasyon flebi ile gerceklestirildi. Kanimizca paraspinal fasyokutan rotasyon flepleri, genis myelomeningosel defektlerinin onariminda greft kullanimina gerek birakmayan en uygun rekonstruksiyon secenegidir. Anahtar kelimeler: Meningomyelosel, Myelomeningosel, Fasyokutan Flep, Perforator Flep.