Plastic Surgery Research Council
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IMPROVING OUTCOMES AND REDUCING MORBIDITY IN CONGENITAL MYELOMENINGOCELE DEFECTS: A COHORT COMPARISON STUDY BETWEEN MUSCLE FLAPS VERSUS ADIPOFASCIAL FLAPS WITH SUPPLEMENTAL DERMAL REGENERATIVE TEMPLATES
Presenter: Oluwaseun A Adetayo, MD
Co-Authors: Argenta A; MacIsaac Z; Grunwaldt LJ; Kumar AR
University of Pittsburgh

Background: Congenital lumbar myelomeningocele present a significant reconstructive challenge. Muscle flap (MF) closure is an accepted technique but can diminish trunk and lower limb strength. Adipofascial (AF) flaps with supplemental dermal regenerative templates (RDM) have the potential to spare innervated core muscles that are critical for wheel chair posture and limited ambulation. The aim of this study is to evaluate the safety and efficacy of AF flaps with supplemental RDM compared to MF.

Methods: A retrospective cohort comparison study of myelomeningocele defects treated with MF (Group 1) or AF flap /RDM (Group 2) was performed over 84 months. Data collected included gender, age, birth weight, defect size, operative technique, RDM placement, complications, reoperation, and length of follow-up. SPSS 2.0 was used for statistical analysis.

Results: Six patients underwent muscle flap repair (Group 1) and six underwent adipofascial/RDM flap repair (Group 2). Average age 37 weeks, weight 3.49 kg, and defect size 24 cm2 in group 1 vs. average age 36.1 weeks, weight 2.89 kg, and defect size 26.9 cm2 in group 2 were not significantly different (p< .623, p< .528, p< .755, respectively). Average follow-up was 22.6 months for Group 1 and 33.8 months for Group 2. In Group 1, 3/6 (50%) patients required multiple > 2 muscle flaps and 3/6 (50%) required additional complex skin flaps for closure. In Group 2, closure was achieved in 7/8 (88%) patients with local adipofascial turnover flaps and supplement RDM alone without complex skin closure and 1/8 (12%) with complex skin closure. Reoperation rate was 1/6 (17%) in Group 1 and none in Group 2 for full dehiscence (p<1.0). Superficial wound complications occurred in 3/6 (50%) of Group 1 and 2/6 (33%) in Group 2 (p<1.0). No CSF leaks or surgical site infections occurred in either group.

Conclusions: MF trended toward higher reoperation rates (17% vs. 0%), higher superficial wound complications 50% vs. 33%) and higher complex skin flap closure rates (50% vs. 12%). By sparing needed core muscles, AF flaps with RDM may present an advantage over MF closure.


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