Expansion for skin closure of large myelomeningoceles [Intérêt de l'expansion pour la fermeture cutanée des larges myéloméningocèles]

摘要

Background: Closure of a large myelomeningocele requires stable durable coverage of the dural reconstruction. Methods: Twenty-seven cases of myelomeningoceles have been treated in the department of pediatric neurosurgery at the Timone Children's Hospital in the last 17 years. Six children have undergone plastic and reconstructive surgery. Among these six children, four were received several months after birth with a large myelomeningocele and underwent cutaneous expansion prior to closure. One child received lateral discharge incisions during the neonatal period. The sixth child, received at 15 years of age for persistent CSF leak despite numerous attempts to close the dura, was treated by rotational dorsal fasciocutaneous flap with dural plastic surgery. Results: In all of the cases, these techniques provided stable and durable closure with a maximum follow-up of 11 years. An expansion complication was observed with exposure of the prosthesis without secondary infection. Conclusions: Cutaneous expansion is the technique of choice for late closure of large myelomeningoceles. It makes it possible to limit wound-healing problems and preserve muscle and skin resources in children who risk pressure sores.