Reconstruction of Myelomeningocele by Lumbar Artery Perforator Plus Flap: Retrospective Analysis of Case Series | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 6, Volume 47, Issue 4, October 2023, Pages 275-282 PDF (16.11 M) | ||
| Document Type: Research article | ||
| DOI: 10.21608/ejprs.2023.319957 | ||
| Authors | ||
| Mohamed Al Sabbahi* 1; Safwat Abou Hashem2; Ashraf M Mostafa3 | ||
| 1The Departments of Plastic & Reconstructive Surgery, School of Medicine, Zagazig University, Egypt, and Saudi German Hospital, Riyadh | ||
| 2The Departments of Neurosurgery, School of Medicine, Zagazig University and Department Neurosurgery, Saudi German Hospital, Riyadh | ||
| 3The Department of Plastic & Reconstructive Surgery, School of Medicine, Zagazig University, Egypt, | ||
| Abstract | ||
| Background: Over the last two decades, a paradigm shift has occurred in the reconstruction of myelomeningocele defects with the emerging concepts of perforator flaps. The use of lumbar perforator flaps for reconstruction of those defects has superseded any other modes of reconstruction. This is attributed to the confidence in flap versatility and low donor site morbidity. Although the flap has good vascular reliability, there's still some risk for venous congestion. Objectives: This study aims to present our experience and the outcome in the reconstruction of myelomeningocele defects using freestyle lumbar perforator plus flap. Methods: Retrospective analysis of 16 newly born infants presented to the plastic surgery department between February 2018 to June 2020 presented with thoracolumbar, lumbosacral, or purely lumbar myelomeningocele. All patients underwent joint neurosurgical and plastic reconstruction procedures. Layered reconstruction was performed and dorsal intercostal or lumbar arteries perforator plus flap were used in all patients. Results: Out of the 16 babies in this study, 15 babies (93.75%) had neurological deficits. The flap dimension ranged from (3.4x5.8cm) to (6x11cm). The blood loss was minimal with a mean of 22±4.5ml. No flap loss had occurred except for one partial 1cm distal necrosis treated conservatively. Follow-up for six months showed good soft tissue coverage in all cases without any need for further reconstructive procedures. Conclusion: The lumbar artery perforator plus flap provides a well vascularized durable coverage, lower rate of complications or morbidity and more aesthetic appearance. | ||
| Keywords | ||
| Myelomeningocele; Perforator plus; Lumbar artery; Dorsal intercostal artery flap | ||
| References | ||
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