PURPOSE: The goals of this study were to review the outcome of the surgical procedure and hospitalization associated with meningomyelocele repair, and to examine the results of different closure strategies.
METHODS: Eighty-three consecutive patients having surgery for meningomyelocele over a ten year period were studied. Thirty-two closures with a mean defect size preoperatively of 11.5 cm2 were performed by the neurosurgeon (ADP), and fifty-one closures with a mean defect size of 28.4 cm² by the plastic surgeon (MFA). Defects up to 12 cm² were closed with local advancement fasciocutaneous flaps. As defect size increased, latissimus muscle flaps were added in 30 (36%) and gluteus muscle in 16 (19%). In recent years, 18 patients (21.6%) with a mean defect of 29 cm² were treated with overlapping of deepithelialized fasciocutaneous flaps to add an additional layer of coverage to the dural closure.
RESULTS: There were 9 major complications, 6 requiring re-operation. There were 10 minor wound failures managed conservatively. Mean hospital stay was 24.2 days. Re-operation increased hospitalization to 45 days (p<0.0001). Wound failure did not correlate with either defect size or closure technique. Thoracic location was associated with increased wound failure (p<0.05). Use of a shunt did not increase morbidity. All closures remained durable after discharge.
CONCLUSION: Location in the thoracic area predicts major wound failure and need for re-operation. Wound complications significantly increase hospital stay. The use of a variety of techniques to achieve multi-layered closures leads to durable coverage for defects of all sizes.