Bilateral latissimus dorsi myocutaneous advancement flap for coverage of thoracolumbar myelomeningocele

Abstract

Background and objective: The myelomeningocele is the most common form of neural tube defect, the early efficient and durable coverage and repair of the dural sac with well-vascularized soft tissue is important for neurological functional outcome and prevention of infection. The latissimus dorsi myo-cutaneous advancement flap is promising in this respect. The objective of the study was to assess the durability and advantages of bilateral latissimus dorsi myo-cutaneous advancement flap for coverage of medium to large-sized thoracolumbar myelomeningocele defects.

Methods: A retrospective study was carried out from 2012-2022, in Erbil (the capital of Kurdistan region, Iraq) at Rozhawa and Erbil Teaching Hospital. Ten infants (four males, and six females), all of them had medium to large thoracolumbar myelomeningocele defects, all managed operatively by two team approach of neurosurgeons and plastic surgeons under general anesthesia, using a bilateral latissimus dorsi myo-cutaneous advancement flap, the defect was closed.

Results: Ten patients were included in the study. Their mean age (SD) was 21.6 (8.3) days, and the age range was 10-35 days. More than half (60%) of the patients were females. The sites of the operation were (thoracic 50%, lumber 40%, and thoraco-lumber 10%). The size was medium in 60% of patients and large in (40%), and the time of the operation was less than two hours in 50% of the patients. Three patients (30%) developed complications, one developed simple edge necrosis, and two developed CSF leakage, and the success rate was 100%.

Conclusion: There are numerous benefits to using a bilateral latissimus dorsi myo-cutaneous advancement flap in comparison to alternative techniques for covering moderate to large thoracolumbar myelomeningocele abnormalities.