Pauline Yap and Arman Zaharil Mat Saad and Wan Azman Wan Sulaimana and Siti Fatimah Noor Mat Johar and Nurul Syazana Mohamad Shah (2021) Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template. Pediatric Traumatology Orthopaedics and Reconstructive Surgery, 9. pp. 345-351. ISSN 2309-3994 (P-ISSN) , 2410-8731 (E-ISSN)
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Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template.pdf Download (42kB) |
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Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template1.pdf Restricted to Registered users only Download (770kB) |
Abstract
BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons. CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra® dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure. DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting. CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.
| Item Type: | Article |
|---|---|
| Keyword: | Myelomeningocele , Wound closure techniques , Integra , Lumbosacral defect , Dermal regeneration template |
| Subjects: | R Medicine > RC Internal medicine > RC31-1245 Internal medicine R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC71-78.7 Examination. Diagnosis Including radiography R Medicine > RD Surgery > RD1-811 Surgery |
| Department: | FACULTY > Faculty of Medicine and Health Sciences |
| Depositing User: | SITI AZIZAH BINTI IDRIS - |
| Date Deposited: | 25 Feb 2022 09:02 |
| Last Modified: | 25 Feb 2022 09:14 |
| URI: | https://eprints.ums.edu.my/id/eprint/29354 |
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