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Immediate post natal myelomeningocele defect closure using rhomboid fasciocutaneous flaps

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
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
N/A
Flap necrosis Dural exposure CSF fistula Wound infection
None
Fernando Rosas Brito for video and image editing
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.

Review Immediate post natal myelomeningocele defect closure using rhomboid fasciocutaneous flaps.

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