Standard protocol for closure and repair of post-meningocele and meningomyelocele back skin defect

Abstract

Background Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele and meningomyelocele are the most common forms of spinal dysraphism. Most cases of myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem is faced intraoperatively during skin closure in some cases. The aim of our work is to describe and make a plan for proper operative management during the clinic visit for ideal repair and closure of the back skin defect. This depends on the area of the defect measured preoperatively to close the defect by properly designing the method of closure by either a flab or a graft. Patients and methods This is a prospective hospital-based study that included 60 patients. According to the defect size (we measured the defect preoperative and intraoperative by sterile ruler), we classified the patients into three groups. The first group was closed directly by simple repair, the second group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one rotational flap), and the third group was closed by skin graft (split-thickness skin graft) owing to a large defect with immobile skin-for-skin flap. Results In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by skin graft. According to the size of the defect, we found that a defect with a total surface area of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80 cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was closed by a skin graft. Conclusion Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice of coverage depends on the surface area and the extent of the lesion, which help in getting the best results for skin repair.