Role of Perforator Flaps in Back Defects Reconstruction

Assiut University

Status: Not yet enrolling

Conditions: Myelomeningocele

Treatments: Procedure: surgical closure of myelomeningocele defects by perforator-plus flaps; Procedure: surgical closure of myelomeningocele defects by perforator flaps

Study type: Interventional

Funder types: Other

Identifiers

NCT06405698

flaps in myelomeningiocele

Details and patient eligibility

About

evaluation of perforator flaps versus perforator plus flaps

Full description

One of the neural tube defects, myelomeningocele, is a congenital anomaly developing in the fourth gestational week. It is characterized by insertion of neural elements into a pouch floored by meninx through a vertebral defect.

The aetiology is multifactorial. causes are genetic properties, geographic factors, and deficiency of folic acid.

Meningomyelocele incidence range between 1 and 2/1000 live births. The defect location can reside anywhere between the cervical region and the sacrum.

surgical closure of the defect is performed to prevent cerebrospinal fluid leakage and central nervous system infections. it is a combined work between neurosurgery and plastic surgery. Fascial turnover flaps, muscle flaps, local fasciocutaneous flaps.

With the emerging concepts of perforator flaps in the last three decades, the reconstruction of myelomeningocele defects has completely changed since the anatomy of the dorsal intercostal artery perforators (DIAP) and lumbar artery perforators(LAP) has been fully studied.

Despite utilizing perforator flaps having greatly improved the outcome of myelomeningocele reconstruction, venous compromise remained a major concern associated with complications.

By preserving, the perforator vessels and minimizing the amount of tissue that is removed, the Perforator Plus technique can improve blood flow and decrease the risk of venous congestion.

Preoperative perforator mapping may be executed by a multitude of diagnostic modalities. Hand-held Doppler (HHD), color-coded duplex sonography (CCDS), computed tomography angiography (CTA), magnetic resonance angiography (MRA) and others may be applied.

Systematic reviews of the literature revealed that CCDS has the highest sensitivity and positive predictive value to identify perforators for flaps.

Enrollment: 30 estimated patients

Sex: All

Ages: 2 days to 1 year old

Volunteers: No Healthy Volunteers

Inclusion criteria

• infants up to one year,
• dorso-lumbar myelomeningocele.
• moderate to large myelomeningocele defects. (25 - 39 cm2 ) .

Exclusion criteria

• cervical myelomeningocele
• very large defects (more than 40 cm2 )
• preterm newborn patients.
• hematological disease
• any problem against prone position of the patient

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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30 participants in 2 patient groups

closure of the myelomeningocele defect by perforator flap.

Experimental group

Description:

fifteen patient with myelomeningocele defect

Treatment:

Procedure: surgical closure of myelomeningocele defects by perforator flaps

closure of the myelomeningocele defect by perforator plus flap .

Experimental group

Description:

fifteen patient with myelomeningocele defect

Treatment:

Procedure: surgical closure of myelomeningocele defects by perforator-plus flaps