DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20223041
Published: 2022-11-25

Closure of a large lumbosacral myelomeningocele post operative defect with a human cadaveric split-thickness skin graft: a case report

Diana E. Campos-Lopez, Nora C. Sauceda-Elenes, Mario A. Martinez-Jimenez, Cristopher Cardenas-Cruz, Lizeth Jiménez-Santana, Mariana G. Jiménez-Sierra, Rito J. Medellin-Cristerna, Alejandro Arias-Mendoza

Abstract


Spina bifida is the most common birth defect of the central nervous system that is compatible with life, and myelomeningocele represents its most frequent form. Congenital myelomeningocele (CMM) has a worldwide incidence of 0.5 to 0.8 per 1,000 live newborns. CMM is a complex condition resulting from incomplete closure of the neural tube, mainly in the lumbosacral region. The objective of the surgical repair of the CMM is the reconstruction of all the tissue layers of the defect, avoiding possible postoperative complications. The aim of this case review is to present a re-epithelialization closure in a patient with a large CMM defect in who primary hermetic closure was not possible because there was too much tension at the edges of the defect. Therefore, human cadaveric split-thickness skin grafts were placed over the dura mater and the aponeurotic layer, covering the entire defect and an adequate healing and completely closure of the defect were observed in eight weeks. The surgical management of large meningomyelocele defects represents a major challenge and no single protocol exists for its reconstruction. The repair of an MMC defect should be performed during the first 72 hours after birth. After neurosurgical closure of the neural tube and dura, the myelomeningocele defect requires good quality skin and subcutaneous tissue with minimal wound tension for stable coverage. Human cadaveric skin grafts are considered a useful technique for temporary wound coverage because they lead to a more natural healing environment, possess ideal properties, and provide a physiological barrier that reduces microbiological contamination, in addition, it acts as a bridge to adhere to and to seal wound beds.


Keywords


Myelomeningocele, Split-thickness skin graft, Cadaveric, Skin closure, Wound healing

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References


Sahni M, Alsaleem M, Ohri A. Meningomyelocele. StatPearls Publishing. Treasure Island (FL): StatPearls Publishing. 2022.

Verity C, Firth H, ffrench-Constant. Congenital abnormalities of the central nervous system. J Neurol Neurosurg Psychiatry. 2003;74(I):3-8.

Lehrman A, Owen MP. Surgical repair of large meningomyeloceles. Ann Plast Surg. 1984;12(6):501-7.

Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR. Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst. 2010;26(8):1091-5.

Carlos Fabián Barrera Novoa, MD; Oswaldo Javier Gómez Díaz, MD Colgajo Keystone flap: a safe, stable and esthetic coverage option in salvage management for myelomeningocele. About 2 cases. SCCP. 2019;25(2).

Zaganjor I, Sekkarie A, Tsang BL, Williams J, Razzaghi H, Mulinare J, Sniezek JE, Cannon MJ, Rosenthal J. Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review. PLoS One. 2016;11(4):e0151586.

Bevan R, Wilson-Jones N, Bhatti I, Patel C, Leach P. How much do plastic surgeons add to the closure of myelomeningoceles? Childs Nerv Syst. 2018;34(4):737-40.

Kemaloǧlu CA, Özyazgan I, Ünverdi ÖF. A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair. J Neurosurg Pediatr. 2016;18(2):187-91.

Bozkurt C, Akin S, Doǧan Ş, Özdamar E, Aytaç S, Aksoy K, et al. Using the sac membrane to close the flap donor site in large meningomyeloceles. Br J Plast Surg. 2004;57(3):273-7.

Basilotta Marquez Y, Ruiz Johnson A, Uez Pata A, Mantese B. Closure of a large lumbosacral myelomeningocele defect with a human pericardial graft: a case report. Child’s Nervous System. 2022;38(4):851-4.

Henn D, Chen K, Maan ZN, Greco AH, Moortgat Illouz SE, Bonham CA, et al. Cryopreserved human skin allografts promote angiogenesis and dermal regeneration in a murine model. Int Wound J. 2020;17(4):925-36.

Wei LG, Chen CF, Wang CH, Cheng YC, Li CC, Chiu WK, et al. 500-gray γ-irradiation may increase adhesion strength of lyophilized cadaveric split-thickness skin graft to wound bed. Ann Plast Surg. 2017;78(3):S135-8.