Delayed and nondelayed bilateral bipedicled fasciocutaneous flaps in large meningomyelocele defects: a preliminary results

Congenital fusion defects of the neural tube and the related structures are classified as spinal dysraphism. Meningomyelocele is a defect which is the most common form of spinal dysraphism and occurs at an approximate rate of 1 in 800-1000 live births. In untreated meningomyelocele patients, mortality rate is 65-70% within the first 6 months. Between 2006 January and 2009 January, 10 (6 female and 4 male) newborns with a meningomyelocele defect large enough that could not repaired primarily were included the our study. In the nondelayed group which were consisted of five newborns whose diameter of the meningomyelocele defect were less than 50%, flaps were advanced to the midline and the defect was closed. In delayed group, we preferred to take advantages of the delaying phenomenon in five newborns whose diameter of the meningomyelocele defect were more than 50% of the mid-axillary distance to prevent disrupting circulation of the flaps. After 1 week, defects were closed following repair of the neural defects and advancement of the delayed flaps. The monitoring of the patients during the delay period revealed no local and central nervous system infection symptoms. In conclusion, we propose that delayed bipedicle flaps as an alternative method for the repair of large meningomyelocele defects due to their simple and reliable nature which also causes less hemorrhage, and we use them on selected patients in our clinic.

“Delay” yapýlmýþ ve yapýlmamýþ bilateral fasyokutan fleplerin, geniþ meningomyelosel defektlerinde kullanýmý: Ön çalýþma sonuçlarý

Nöral tüp ve iliþkili yapýlarýn konjenital füzyon defektleri spinal disrafizm olarak sýnýflandýrýlmaktadýr. Meningonyelosel spinal disrafizm defektlerinin en sýk görülenidir ve 800-1000 canlý doðumda 1 görülmektedir. Tedavi edilmemiþ meningomyeloselli hastalarda ilk 6 ayda mortalite oraný %65 ile 70 arasýndadýr. Ocak 2006 ile Ocak 2011 arasýnda primer kapatýlamayacak kadar geniþ meningomyelosel defekti olan 10 (6 kýz ve 4 erkek) yenidoðan çalýþmamýza dahil edildi. “Delay” yapýlmamýþ fasyokutan flep uygulanan 5 yenidoðanýn meningomyelosel defekti %50’den azdý ve bu fasyokutan flepler delay yapýlmadan orta hatta ilerletilerek primer kapatýldý. “Delay” yapý- lan grup da 5 yeni doðandan oluþmaktaydý ve bu grupta meningomyelosel defekt boyutu orta aksiller hattan itibaren ölçüldüðünde %50’den fazla olmasý nedeni ile fleplerde dolaþým problemlerini önlemek amacý ile delay fenomeninin avantajlarýndan yararlanýldý. Flep “delay” yapýlmasýndan bir hafta sonra nöral defekt onarýldý ve flepler orta hatta ilerletildi. Flep delayinin beklenilmesi aþamasýnda hastalarýn takibinde lokal veya santral sinir sistemi enfeksiyonlarý izlenmedi. Sonuç olarak, “delay” yapýlmýþ bipediküllü flepler geniþ meningomyelosel defektlerin onarýmýnda basit ve güvenilir ve daha az hemorajiye neden olmalarý nedeni ile alternatif bir yöntem olduðunu düþünmekteyiz ve kliniðimizde seçilmiþ hastalarda kullanmaktayýz.