Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template
| Autor: | Mat Johar Siti Fatimah Noor, Arman Zaharil Mat Saad, Mat Saad Arman Zaharil, Wan Sulaiman Wan Azman, Nurul Syazana Mohamad Shah, Siti Fatimah Noor Mat Johar, Pauline Yap, Wan Azman Wan Sulaiman, Mohamad Shah Nurul Syazana, Yap Pauline |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
integumentary system Spina bifida business.industry Regeneration (biology) medicine.medical_treatment Combined use medicine.disease Surgery Lumbar Negative-pressure wound therapy Pediatrics Perinatology and Child Health medicine Skin grafting Orthopedics and Sports Medicine business Combined method Lumbosacral joint |
| Zdroj: | Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 9:345-351 |
| ISSN: | 2410-8731 2309-3994 |
| DOI: | 10.17816/ptors71191 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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