Background
Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele
and meningomyelocele are the most common forms of spinal dysraphism. Most cases of
myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem
is faced intraoperatively during skin closure in some cases. The aim of our work is to describe
and make a plan for proper operative management during the clinic visit for ideal repair and
closure of the back skin defect. This depends on the area of the defect measured preoperatively
to close the defect by properly designing the method of closure by either a flab or a graft.
Patients and methods
This is a prospective hospital‑based study that included 60 patients. According to the defect
size (we measured the defect preoperative and intraoperative by sterile ruler), we classified
the patients into three groups. The first group was closed directly by simple repair, the second
group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one
rotational flap), and the third group was closed by skin graft (split‑thickness skin graft) owing
to a large defect with immobile skin‑for‑skin flap.
Results
In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by
skin graft. According to the size of the defect, we found that a defect with a total surface area
of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80
cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was
closed by a skin graft.
Conclusion
Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice
of coverage depends on the surface area and the extent of the lesion, which help in getting
the best results for skin repair.