Adipofascial Flaps With Acellular Dermal Matrix Compared With Myocutaneous Flap Reconstruction in Lumbar Myelomeningocele Defects. Issue 5 (July 2018)

• Record Type: Journal Article
• Authors: Pourtaheri, Navid; Wang, Derek; Calva, Daniel; Chopra, Karan; Kumar, Anand R.
• Is Part Of: Journal of craniofacial surgery. Volume 29:Issue 5(2018)
• Publication Date: 2018-07
• Subjects: Acellular dermal matrix -- adipofascial flaps -- lumbar wound reconstruction -- myelomeningocele -- pediatric soft tissue defects; Facial bones -- Surgery -- Periodicals; Skull -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; 617.52
• DOI: 10.1097/SCS.0000000000004598
• Languages: English
• ISSNs: 1049-2275

Abstract

Abstract : Background: Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for long-term function. Comparative studies between myocutaneous flap (MF) reconstruction, the accepted standard reconstructive technique, and AFF/ADM remain under-reported. The aim of this study was to evaluate the safety and efficacy of myelomeningocele reconstruction using muscle sparing AFF/ADM versus MF. Methods: A retrospective comparison was conducted on consecutive myelomeningocele patients reconstructed with MF or AFF/ADM over an 84-month period. Data analyzed included: basic demographics, defect size, reconstructive technique, complications, and length of follow-up. A supplemental meta-analysis based on systematic review of literature was performed to compare alternative reconstructive options. Results: Twelve patients were identified who met inclusion criteria. Median age, weight, and defect size at reconstruction in the AFF/ADM group (n = 6) was 37.5 weeks, 3.25 kg, and 20.0 cm 2, respectively, and in the MF group (n = 6) was 37 weeks, 3.6 kg, and 22.5 cm 2 ( P > 0.5). For the AFF/ADM versus MF groups, median follow-up was 33.8 versus 22.6 months, reoperation rate was 0% versus 17% ( P = 1.0), and complex skin flap closure rate was 17% versus 100% ( P = 0.015). No cerebrospinal fluid leaks or surgical site infections occurred in either group. Meta-analysis of the literature revealed no statistically significant difference in complications rates between muscle and nonmuscle flap reconstruction ( P > 0.5); potential long-term sequelae of muscle flap harvest were not included. Conclusions: Muscle sparing AFF with ADM is a safe and effective surgical alternative to muscle flaps for lumbar myelomeningocele reconstruction.