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Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap

The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free...

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Autores principales: Jamjoom, Hytham, Alnoman, Hatem, Almadani, Yasser
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222641/
https://www.ncbi.nlm.nih.gov/pubmed/28293496
http://dx.doi.org/10.1097/GOX.0000000000001114
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author Jamjoom, Hytham
Alnoman, Hatem
Almadani, Yasser
author_facet Jamjoom, Hytham
Alnoman, Hatem
Almadani, Yasser
author_sort Jamjoom, Hytham
collection PubMed
description The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable.
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spelling pubmed-52226412017-03-14 Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap Jamjoom, Hytham Alnoman, Hatem Almadani, Yasser Plast Reconstr Surg Glob Open Case Report The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable. Wolters Kluwer Health 2016-12-13 /pmc/articles/PMC5222641/ /pubmed/28293496 http://dx.doi.org/10.1097/GOX.0000000000001114 Text en Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Case Report
Jamjoom, Hytham
Alnoman, Hatem
Almadani, Yasser
Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title_full Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title_fullStr Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title_full_unstemmed Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title_short Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap
title_sort closure of a large thoracolumbar myelomeningocele using a modified bilateral keystone flap
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222641/
https://www.ncbi.nlm.nih.gov/pubmed/28293496
http://dx.doi.org/10.1097/GOX.0000000000001114
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