Repair of spina bifida cystica: an institutional experience

Abstract

Abstract Objective Although most cases with spina bifida cystica could be closed by primary skin closure with or without undermining its edges, about 25% of patients have large defects not amenable for closure by these simple methods. We conducted this study to review our techniques in closing spina bifida cystica defects. Methods We retrospectively reviewed the data of consecutive 21 patients diagnosed with spina bifida cystica in our setting. According to the surface area of the defect, the approach was decided; primary closure for small defects (11 cases) and flap-based approach for large defects (10 patients). Results The age of the included pediatric patients ranged between 3 and 75 days. For the primary closure cases, a vertical incision was done in seven cases. For the flap-based group, bilateral rotation transposition flap was done for circular defects (7 cases) while elliptical ones were repaired via bilateral V–Y flap. Complete skin healing was achieved after two weeks (range 12–18 days) in most cases. Complications were as follows; for the primary closure group, cerebrospinal fluid leakage (18.18%%), partial wound dehiscence (18.18%) and superficial surgical site infection (9.09%). In the flap-based group, CSF leakage (20%), superficial surgical site infection (10%), and distal flap necrosis (30%) were detected. Reoperation for wound complication was needed only in one case in the flap-based group. Conclusions Flap-based procedures are recommended for patients with large spina bifida cystica defects because of less tissue dissection and low complication rates. Primary closure should be kept for small defects.

Keywords

• Spina bifida cystica
• Large defects
• Closure technique