Skip to main content
Top
Published in: Acta Neurochirurgica 7/2014

01-07-2014 | Clinical Article - Pediatrics

Use of the bovine pericardial patch and fibrin sealant in meningomyelocele closure

Authors: Bora Gürer, Hayri Kertmen, Umut Dogu Akturk, Mehmet Kalan, Zeki Sekerci

Published in: Acta Neurochirurgica | Issue 7/2014

Login to get access

Abstract

Background

Meningomyelocele is the most common and complex birth defect of the central nervous system. The operative principle of meningomyelocele repair consists of consecutive separate closures of the neural placode, dura mater, lumbar fascia, subcutaneous layer, and skin. While the neurosurgical techniques for the closure of the neural placode and dura mater have been well accepted, the most appropriate soft tissue closure technique has not yet been applied.

Methods

This study reviews a case series of eight meningomyelocele patients treated with the bovine pericardial patch and fibrin sealant. Following the reconstruction of the neural placode and the closure of the dura mater, soft tissue coverage was achieved using the bovine pericardial patch and fibrin sealant.

Results

In this series of eight patients, stable coverage was achieved with the application of a bovine pericardial patch and fibrin sealant technique. After the operations, none of the possible complications such as cerebrospinal fluid leak, seroma, hematoma, skin necrosis, deep or superficial infection, and wound breakdown was observed.

Conclusions

The usage of the bovine pericardial patch and fibrin sealant technique at the fascial level–between the dural sac and the skin–provides adequate soft tissue coverage in meningomyelocele repair surgery.
Literature
1.
go back to reference Agag RL, Granick MS, Omidi M, Catrambone J, Benevenia J (2004) Neurosurgical reconstruction with acellular cadaveric dermal matrix. Ann Plast Surg 52:571–577PubMedCrossRef Agag RL, Granick MS, Omidi M, Catrambone J, Benevenia J (2004) Neurosurgical reconstruction with acellular cadaveric dermal matrix. Ann Plast Surg 52:571–577PubMedCrossRef
2.
go back to reference Akan IM, Ulusoy MG, Bilen BT, Kapucu MR (1999) Modified bilateral advancement flap: the slide-in flap. Ann Plast Surg 42:545–548PubMedCrossRef Akan IM, Ulusoy MG, Bilen BT, Kapucu MR (1999) Modified bilateral advancement flap: the slide-in flap. Ann Plast Surg 42:545–548PubMedCrossRef
3.
go back to reference Arad E, Barnea Y, Gur E, Amir A, Leshem D, Zaretski A, Rochkind S, Beny L, Constantini S, Weiss J (2006) Paravertebral turnover flaps for closure of large spinal defects following tethered cord repair. Ann Plast Surg 57:642–655PubMedCrossRef Arad E, Barnea Y, Gur E, Amir A, Leshem D, Zaretski A, Rochkind S, Beny L, Constantini S, Weiss J (2006) Paravertebral turnover flaps for closure of large spinal defects following tethered cord repair. Ann Plast Surg 57:642–655PubMedCrossRef
4.
go back to reference Bajaj PS, Welsh F, Shadid EA (1979) Versatility of lumbar transposition flaps in the closure of meningomyelocele skin defects. Ann Plast Surg 2:103–108PubMedCrossRef Bajaj PS, Welsh F, Shadid EA (1979) Versatility of lumbar transposition flaps in the closure of meningomyelocele skin defects. Ann Plast Surg 2:103–108PubMedCrossRef
5.
go back to reference Bozkurt C, Akin S, Doğan S, Ozdamar E, Aytaç S, Aksoy K, Erol O (2004) Using the sac membrane to close the flap donor site in large meningomyeloceles. Br J Plast Surg 57:273–277PubMedCrossRef Bozkurt C, Akin S, Doğan S, Ozdamar E, Aytaç S, Aksoy K, Erol O (2004) Using the sac membrane to close the flap donor site in large meningomyeloceles. Br J Plast Surg 57:273–277PubMedCrossRef
6.
go back to reference Chauvet D, Tran V, Mutlu G, George B, Allain JM (2011) Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien) 153:2465–2472CrossRef Chauvet D, Tran V, Mutlu G, George B, Allain JM (2011) Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien) 153:2465–2472CrossRef
7.
go back to reference Clark DH, Walsh JW, Luce EA (1982) Closure of myelorachischisis defects with reverse latissimus dorsi myocutaneous flaps. Neurosurgery 11:423–425PubMedCrossRef Clark DH, Walsh JW, Luce EA (1982) Closure of myelorachischisis defects with reverse latissimus dorsi myocutaneous flaps. Neurosurgery 11:423–425PubMedCrossRef
8.
go back to reference Cruz NI, Ariyan S, Duncan CC, Cuono CB (1983) Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note. J Neurosurg 59:714–717PubMedCrossRef Cruz NI, Ariyan S, Duncan CC, Cuono CB (1983) Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note. J Neurosurg 59:714–717PubMedCrossRef
9.
go back to reference De Brito Henriques JG, Filho GP, Gusmão SN, Henriques KS, Miranda ME (2007) Intraoperative acute tissue expansion for the closure of large myelomeningoceles. J Neurosurg 107(2 Suppl):98–102PubMed De Brito Henriques JG, Filho GP, Gusmão SN, Henriques KS, Miranda ME (2007) Intraoperative acute tissue expansion for the closure of large myelomeningoceles. J Neurosurg 107(2 Suppl):98–102PubMed
10.
go back to reference Fiala TG, Buchman SR, Muraszko KM (1996) Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery 39:522–525PubMed Fiala TG, Buchman SR, Muraszko KM (1996) Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery 39:522–525PubMed
12.
go back to reference Gérard JM, Gersdorff M (2006) The Tutopatch graft for transcanal myringoplasty. B-ENT 2:177–179PubMed Gérard JM, Gersdorff M (2006) The Tutopatch graft for transcanal myringoplasty. B-ENT 2:177–179PubMed
13.
go back to reference Haq IZ, Akmal S, Chandler CL, Bassi S (2012) Review of practices in myelomeningocoele repair at King's College Hospital, London. Br J Neurosurg 26:851–855PubMedCrossRef Haq IZ, Akmal S, Chandler CL, Bassi S (2012) Review of practices in myelomeningocoele repair at King's College Hospital, London. Br J Neurosurg 26:851–855PubMedCrossRef
14.
go back to reference Hasegawa M, Fujisawa H, Hayashi Y, Yamashita J (2004) Autologous amnion graft for repair of myelomeningocele: technical note and clinical implication. J Clin Neurosci 11:408–411PubMedCrossRef Hasegawa M, Fujisawa H, Hayashi Y, Yamashita J (2004) Autologous amnion graft for repair of myelomeningocele: technical note and clinical implication. J Clin Neurosci 11:408–411PubMedCrossRef
15.
go back to reference Hill SM, Elwood ET, Lin J (2012) Closure of meningomyelocele defects using acellular dermal matrix. J Neurosurg Pediatr 9:156–60PubMedCrossRef Hill SM, Elwood ET, Lin J (2012) Closure of meningomyelocele defects using acellular dermal matrix. J Neurosurg Pediatr 9:156–60PubMedCrossRef
16.
go back to reference Hosseinpour M, Forghani S (2009) Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps. J Neurosurg Pediatr 3:331–333PubMedCrossRef Hosseinpour M, Forghani S (2009) Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps. J Neurosurg Pediatr 3:331–333PubMedCrossRef
17.
go back to reference Hutchinson RW, Mendenhall V, Abutin RM, Muench T, Hart J (2011) Evaluation of fibrin sealants for central nervous system sealing in the mongrel dog durotomy model. Neurosurgery 69:921–928PubMedCrossRef Hutchinson RW, Mendenhall V, Abutin RM, Muench T, Hart J (2011) Evaluation of fibrin sealants for central nervous system sealing in the mongrel dog durotomy model. Neurosurgery 69:921–928PubMedCrossRef
18.
go back to reference Isik D, Tekes L, Eseoglu M, Isik Y, Bilici S, Atik B (2011) Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg 67:159–163PubMedCrossRef Isik D, Tekes L, Eseoglu M, Isik Y, Bilici S, Atik B (2011) Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg 67:159–163PubMedCrossRef
19.
go back to reference Komuro Y, Yanai A, Koga Y, Seno H, Inoue M (2006) Bilateral modified V-Y advancement flaps for closing meningomyelocele defects. Ann Plast Surg 57:195–198PubMedCrossRef Komuro Y, Yanai A, Koga Y, Seno H, Inoue M (2006) Bilateral modified V-Y advancement flaps for closing meningomyelocele defects. Ann Plast Surg 57:195–198PubMedCrossRef
20.
go back to reference Lapid O, Rosenberg L, Cohen A (2001) Meningomyelocele reconstruction with bilobed flaps. Br J Plast Surg 54:570–572PubMedCrossRef Lapid O, Rosenberg L, Cohen A (2001) Meningomyelocele reconstruction with bilobed flaps. Br J Plast Surg 54:570–572PubMedCrossRef
21.
22.
go back to reference Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR (2010) Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst 26:1091–1095PubMedCrossRef Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR (2010) Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst 26:1091–1095PubMedCrossRef
23.
go back to reference Mankad PS, Codispoti M (2001) The role of fibrin sealants in hemostasis. Am J Surg 182(2 Suppl):21S–28SPubMedCrossRef Mankad PS, Codispoti M (2001) The role of fibrin sealants in hemostasis. Am J Surg 182(2 Suppl):21S–28SPubMedCrossRef
24.
go back to reference McCraw JB, Penix JO, Freeman BG, Vincent MP, Wirth FH (1987) Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps. Ann Plast Surg 18:147–155PubMedCrossRef McCraw JB, Penix JO, Freeman BG, Vincent MP, Wirth FH (1987) Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps. Ann Plast Surg 18:147–155PubMedCrossRef
26.
go back to reference Moore TS, Dreyer TM, Bevin AG (1984) Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast Reconstr Surg 73:288–292PubMedCrossRef Moore TS, Dreyer TM, Bevin AG (1984) Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast Reconstr Surg 73:288–292PubMedCrossRef
27.
go back to reference Munro IR, Neu BR, Humphreys RP, Lauritzen CG (1983) Limberg-latissimus dorsi myocutaneous flap for closure of myelomeningocele. Childs Brain 10:381–386PubMed Munro IR, Neu BR, Humphreys RP, Lauritzen CG (1983) Limberg-latissimus dorsi myocutaneous flap for closure of myelomeningocele. Childs Brain 10:381–386PubMed
28.
go back to reference Mutaf M, Bekerecioğlu M, Erkutlu I, Bulut O (2007) A new technique for closure of large meningomyelocele defects. Ann Plast Surg 59:538–543PubMedCrossRef Mutaf M, Bekerecioğlu M, Erkutlu I, Bulut O (2007) A new technique for closure of large meningomyelocele defects. Ann Plast Surg 59:538–543PubMedCrossRef
29.
go back to reference Mutaf M, Temel M, Günal E (2012) The reading man flap for closure of large meningomyelocele defects. J Plast Reconstr Aesthet Surg 65:578–583PubMedCrossRef Mutaf M, Temel M, Günal E (2012) The reading man flap for closure of large meningomyelocele defects. J Plast Reconstr Aesthet Surg 65:578–583PubMedCrossRef
30.
go back to reference Ozçelik D, Yildiz KH, Iş M, Döşoğlu M (2005) Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques). Neurosurg Rev 28:218–225PubMedCrossRef Ozçelik D, Yildiz KH, Iş M, Döşoğlu M (2005) Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques). Neurosurg Rev 28:218–225PubMedCrossRef
31.
go back to reference Patel KB, Taghinia AH, Proctor MR, Warf BC, Greene AK (2012) Extradural myelomeningocele reconstruction using local turnover fascial flaps and midline linear skin closure. J Plast Reconstr Aesthet Surg 65:1569–1572PubMedCrossRef Patel KB, Taghinia AH, Proctor MR, Warf BC, Greene AK (2012) Extradural myelomeningocele reconstruction using local turnover fascial flaps and midline linear skin closure. J Plast Reconstr Aesthet Surg 65:1569–1572PubMedCrossRef
32.
go back to reference Sarifakioglu N, Bingül F, Terzioglu A, Ates L, Aslan G (2003) Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects. Br J Plast Surg 56:303–306PubMedCrossRef Sarifakioglu N, Bingül F, Terzioglu A, Ates L, Aslan G (2003) Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects. Br J Plast Surg 56:303–306PubMedCrossRef
33.
go back to reference Scheflan M, Mehrhof AI Jr, Ward JD (1984) Meningomyelocele closure with distally based latissimus dorsi flap. Plast Reconstr Surg 73:956–959PubMedCrossRef Scheflan M, Mehrhof AI Jr, Ward JD (1984) Meningomyelocele closure with distally based latissimus dorsi flap. Plast Reconstr Surg 73:956–959PubMedCrossRef
34.
go back to reference Seidel SB, Gardner PM, Howard PS (1996) Soft-tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 37:310–316PubMedCrossRef Seidel SB, Gardner PM, Howard PS (1996) Soft-tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 37:310–316PubMedCrossRef
35.
go back to reference Semprini G, Cattin F, De Biasio F, Cedolini C, Parodi PC (2012) The bovine pericardial patch in breast reconstruction: a case report. G Chir 33:392–394PubMed Semprini G, Cattin F, De Biasio F, Cedolini C, Parodi PC (2012) The bovine pericardial patch in breast reconstruction: a case report. G Chir 33:392–394PubMed
36.
go back to reference Talamonti G, D'Aliberti G, Collice M (2007) Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 107(5 Suppl):368–386PubMed Talamonti G, D'Aliberti G, Collice M (2007) Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 107(5 Suppl):368–386PubMed
37.
go back to reference Tamburrini G, Frassanito P, Iakovaki K, Pignotti F, Rendeli C, Murolo D, Di Rocco C (2013) Myelomeningocele: the management of the associated hydrocephalus. Childs Nerv Syst 29:1569–1579PubMedCrossRef Tamburrini G, Frassanito P, Iakovaki K, Pignotti F, Rendeli C, Murolo D, Di Rocco C (2013) Myelomeningocele: the management of the associated hydrocephalus. Childs Nerv Syst 29:1569–1579PubMedCrossRef
38.
go back to reference Turhan Haktanir N, Eser O, Demir Y, Aslan A, Köken R, Melek H (2008) Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method. Turk Neurosurg 18:311–315PubMed Turhan Haktanir N, Eser O, Demir Y, Aslan A, Köken R, Melek H (2008) Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method. Turk Neurosurg 18:311–315PubMed
39.
40.
go back to reference Zakaria Y, Hasan EA (2010) Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 63:1513–1518PubMedCrossRef Zakaria Y, Hasan EA (2010) Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 63:1513–1518PubMedCrossRef
Metadata
Title
Use of the bovine pericardial patch and fibrin sealant in meningomyelocele closure
Authors
Bora Gürer
Hayri Kertmen
Umut Dogu Akturk
Mehmet Kalan
Zeki Sekerci
Publication date
01-07-2014
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-014-2099-4

Other articles of this Issue 7/2014

Acta Neurochirurgica 7/2014 Go to the issue