Immediate post natal myelomeningocele defect closure using rhomboid fasciocutaneous flaps

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
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Author: Dov Goldenberg
Published:
Specialties: Craniofacial and Pediatric Plastic Surgery, Neurosurgery, Plastic Surgery, Reconstructive
Schools: University of Sao Paulo Medical School
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Basic Info

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

Advanced

Procedure

Lumbosacral myelomeningocele defect closure using rhomboid fasciocutaneous flaps carried out at time zero after birth.

Indications

Soft tissue coverage after dural repair and neural repair of myelomeningocele.

Contraindications

Clinical perinatal problems

Instrumentation

Setup

After neurosurgical repair, patient in prone position
Control of room temperature
Latex free environement
Sterile preparations
Bilateral demarcation of flaps
Hidratation of dural repair

Preoperative Workup

Adequate scheduling with obstetric team for C-section delivery and neurosurgical team for dural repair
Stable clinical condition after delivery

Anatomy and Landmarks

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

Advantages/Disadvantages

Complications/Risks

Flap necrosis
Dural exposure
CSF fistula
Wound infection

Disclosure of Conflicts

None

Acknowledgements

Fernando Rosas Brito for video and image editing

References

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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