Analysis of wound complications of patients with meningomyelocele

Abstract

Aims: During the closure of meningomyelocele defects, complications such as dehiscence, flap loss, or cerebrospinal fluid (CSF) leaks may be encountered. There are multiple variables that have not been studied including defect size, surgical method for closure, or patient weight that may take a role during this process. Subjects and Methods: Records of patients operated between February 2015 and August 2018 were retrospectively reviewed. Age and weight at the time of operation, gender, location and size of the defect, method of closure, operative time, pre- and post-operative hemoglobin (Hb) levels, postoperative complications, and revision surgeries if needed were reviewed. Results: Among 28 patients included in the study, 9 (32.1%) patients had postoperative wound complications including partial flap loss, dehiscence, and CSF leaks. Pre- and post-operative Hb levels showed statistically significant difference between primary cases and revision cases (P < 0.001). Defect size, change in Hb levels, and postoperative complication rates did not differ between techniques for closure, yet operative time was significantly increased in butterfly flap group. Increasing defect size was found to be associated with longer operative time and postoperative CSF leakage (P = 0.002 and P = 0.05, respectively) but showed no significant relationship with flap necrosis, dehiscence, and intraoperative blood loss (P = 0.110, P = 0.113, and P = 0.84, respectively). Conclusions: Rotation/advancement fasciocutaneous flaps provide a durable single-stage reconstruction for meningomyelocele defects. The need for transfusion must be kept in mind during primary cases. Correct choosing and application of each method limits complications even with larger defects; however, increasing defect size leads to CSF leaks and prolonged operative time.

Keywords

• complication analysis
• meningomyelocele
• meningomyelocele complications