Email this article Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template
- Authors: Yap P.1,2, Mat Saad A.2,3, Wan Sulaiman W.2, Mat Johar S.2, Mohamad Shah N.2
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Affiliations:
- Universiti Malaysia Sabah
- Universiti Sains Malaysia
- Management and Science University
- Issue: Vol 9, No 3 (2021)
- Pages: 345-351
- Section: Clinical cases
- URL: https://journals.rcsi.science/turner/article/view/71191
- DOI: https://doi.org/10.17816/PTORS71191
- ID: 71191
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Abstract
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.
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##article.viewOnOriginalSite##About the authors
Pauline Yap
Universiti Malaysia Sabah; Universiti Sains Malaysia
Email: paulineyap@live.com
ORCID iD: 0000-0002-2228-3473
MD
Malaysia, Kota Kinabalu, Sabah; 16150 Kubang Kerian, KelantanArman Zaharil Mat Saad
Universiti Sains Malaysia; Management and Science University
Email: armanzaharil@gmail.com
ORCID iD: 0000-0002-4003-6783
M.Sc., Professor
Malaysia, 16150 Kubang Kerian, Kelantan; Shah Alam, SelangorWan Azman Wan Sulaiman
Universiti Sains Malaysia
Email: wsazman@yahoo.com
ORCID iD: 0000-0002-0600-9765
M.Sc., Professor
Malaysia, 16150 Kubang Kerian, KelantanSiti Fatimah Noor Mat Johar
Universiti Sains Malaysia
Email: fatimahmj@usm.my
ORCID iD: 0000-0003-4120-4918
M.Sc.
Malaysia, 16150 Kubang Kerian, KelantanNurul Syazana Mohamad Shah
Universiti Sains Malaysia
Author for correspondence.
Email: syazanashah@usm.my
ORCID iD: 0000-0001-6731-9962
PhD
Malaysia, 16150 Kubang Kerian, KelantanReferences
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