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Myelomeningocele is the most common form of neural tube defect, developing after the 4th week of gestation. Although diagnosed prenatally, many patients did not have a chance to be treated before birth. The best approach in these situation is to perform surgical treatment at time zero. A multidisciplinary team must be prepared to perform dural repair and soft tissue coverage. This video illustrates our approach for soft tissue reconstruction using rhomboid fasciocutaneous flaps with maximal preservation of perforator vessels.
Contributors
Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Tatiana Moura, MD, MSc, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Lumbosacral myelomeningocele defect closure using rhomboid fasciocutaneous flaps carried out at time zero after birth.
Soft tissue coverage after dural repair and neural repair of myelomeningocele.
Clinical perinatal problems
N/A
After neurosurgical repair, patient in prone position
Control of room temperature
Latex free environement
Sterile preparations
Bilateral demarcation of flaps
Hidratation of dural repair
Adequate scheduling with obstetric team for C-section delivery and neurosurgical team for dural repair
Stable clinical condition after delivery
Defect size measurement
Flap markings performed bilaterally before incisions
Fasciocutaneous flap elevation preserving perforators
Identifications of gluteal fat pad
identification of latissimus dorsi and paravertebral muscles
Flap necrosis
Dural exposure
CSF fistula
Wound infection
None
Pinto FC, Matushita H, Furlan AL, Alho EJ, Goldenberg DC, Bunduki V, Krebs VL, Teixeira MJ. Surgical treatment of myelomeningocele carried out at 'time zero' immediately after birth. Pediatr Neurosurg. 2009;45(2):114-8. doi: 10.1159/000209285. Epub 2009 Mar 21.
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