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Page 68
allied
academies
Volume 2
June 11-13, 2018 | London, UK
Neurology and Neuroscience
6
th
International Conference on
Clinical outcome of V-Y Flap with latissimus dorsi and gluteal advancement for treatment of large
thoracolumbar myelomeningocele defects: A Comparative Study
Fariborz Ghaffarpasand, Mohammad Sadegh Masoudi
and
Mohammad Ali Hoghughi
Shiraz University of Medical Sciences, Iran
Objective:
Surgical repair and closing the myelomeningocele
(MMC) defects is important and vital as the mortality rate is as
high as 65%-70% in untreated patients. Closing the large MMC
defects has been a dilemma to pediatric neurosurgeons and
plastic surgeons. The aim of the current study is to report the
operative characteristics and outcome of a series of Iranian
patients with large myelomeningocele defects utilizing V-Y flap
and with latissimus dorsi and gluteal muscles advancement.
Methods:
Thisprospectivecase-controlledstudywas conducted
during a 4-year period fromSeptember 2013 toOctober 2017 in
pediatric neurosurgery department of Shiraz Namazi hospital,
Southern Iran. We included a total number of 24 patients with
large MMC defects who were operated utilizing the bilateral
V-Y flap and latissimus dorsi and gluteal advancement. We
also retrospectively recruited 19 patients with age, gender
and defect size matched controls who were operated using
the primary or delayed closure techniques in our center. At
least 2 year of follow-up was conducted. The frequency of
leakage, necrosis, dehiscence, systemic infection (sepsis,
pneumonia), need for ventriculoperitoneal (VP) shunt insertion
and mortality was compared between the two study groups.
Results:
The bilateral V-Y flap with muscle advancement was
associatedwithsignificantlylongeroperationduration(p<0.001)
and larger amounts of intraoperative bleeding (p=0.007) when
compared to the primary closure group. Those undergoing
bilateral V-Y flap with muscle advancement had significantly
lower rates of surgical site infection (p=0.038), wound
dehiscence (p=0.013) and postoperative CSF leakage (p=0.030)
when compared to those undergoing primary repair. Bilateral
V-Y flap with muscle advancement was also associated with
lower mortality rate [p=0.038; OR (95% CI): 5.09 (1.12-23.1)]
compared to the primary closure. In those undergoing bilateral
V-Y flap and muscle advancement, longer operation duration
was significantly associated with mortality (p=0.008), In the
same way, surgical site infection (p=0.032), wound dehiscence
(p=0.011) and postoperative leakage (p=0.011) were predictors
of mortality. Neonatal sepsis (p=0.002) and postoperative NEC
(p=0.011)wereamongotherpredictorsofmortalityinthisgroup.
Conclusion:
The bilateral V-Y flap with latissimus dorsi and
gluteal advancement is a safe and effective surgical approach for
coveringthelargeMMCdefectsbeingassociatedwithlowerrates
of surgical site infection, dehiscence, CSF leakage and mortality.
Furtherstudiesarerequiredtoelucidatethelong-termoutcomes.
e:
fariborz.ghaffarpasand@gmail.com