Background: Over the last two decades, a paradigm shift
has occurred in the reconstruction of myelomeningocele
defects with the emerging concepts of perforator flaps. The
use of lumbar perforator flaps for reconstruction of those
defects has superseded any other modes of reconstruction.
This is attributed to the confidence in flap versatility and low
donor site morbidity. Although the flap has good vascular
reliability, there's still some risk for venous congestion.
Objectives: This study aims to present our experience
and the outcome in the reconstruction of myelomeningocele
defects using freestyle lumbar perforator plus flap.
Methods: Retrospective analysis of 16 newly born infants
presented to the plastic surgery department between February
2018 to June 2020 presented with thoracolumbar, lumbosacral,
or purely lumbar myelomeningocele. All patients underwent
joint neurosurgical and plastic reconstruction procedures.
Layered reconstruction was performed and dorsal intercostal
or lumbar arteries perforator plus flap were used in all patients.
Results: Out of the 16 babies in this study, 15 babies
(93.75%) had neurological deficits. The flap dimension ranged
from (3.4x5.8cm) to (6x11cm). The blood loss was minimal
with a mean of 22±4.5ml. No flap loss had occurred except
for one partial 1cm distal necrosis treated conservatively.
Follow-up for six months showed good soft tissue coverage
in all cases without any need for further reconstructive procedures.
Conclusion: The lumbar artery perforator plus flap provides
a well vascularized durable coverage, lower rate of
complications or morbidity and more aesthetic appearance.