Flap Closure in Neonatal Neural Tube Defects: Challenges in Flap Design and Lessons Learnt

Background

Management of neural tube defects (NTDs) is challenging and the outcome is demanding.

Aims

To analyze the outcomes in operated cases of NTDs closed using various types of flaps.

Materials and Methods

The data between June 2017 and May 2023 were analyzed. The mode of presentation, timing of intervention, type of flap, neurological status after closure, status of the wound, presence of hydrocephalous, flap blackening, flap necrosis, features of sepsis, and the outcome were recorded and analyzed. Covered NTD; closure done using primary closure or 'Z' Plasty (everywhere); incomplete data; lost to follow-up; and not giving consent were excluded from the study.

Results

Out of 92 cases, 35 were operated using the rhomboid flap, 33 using dufourmentel modification of limberg flap, and 24 using keystone island flap. The mean age at presentation was 4 days (range: 0-28 days). The mean duration of surgery after presentation was 2 days (range: 1-3 days). Mean operating time was 1.15 h (range: 0.45-3.15 h). A ventriculoperitoneal shunt was required in 62 cases at various stages. The preoperative and the postoperative power were nearly the same in all. Wound infection was seen in 2, 3, and 1 cases in each group. Blackening of the flap was seen in 3, 2, and 1 cases in three groups. Cerebrospinal fluid (CSF) leak was seen in 2, 2, and 0 cases. Wound dehiscence was present in one case in each group and sepsis was present in 2, 3, and 2, respectively.

Conclusion

The management of open NTD requires adequate planning. CSF shunting and flap closure are often required.

Keystone Island Flap for Reconstructive Surgery-A Novel Approach

Keystone island flaps have a growing array of applications in reconstructive surgeries for the closure of simple and complex defects following the excision of skin tumors. It is a trapezoidal-shaped flap based on fasciocutaneous perforators. We share our experience with a 79-year-old man, who underwent keystone island flap reconstruction after the excision of biopsy-proven Bowen's disease. A good aesthetic and functional outcome was obtained. With an ever expanding repertoire of reconstructive surgical techniques, the individualization of defect closure is of paramount importance in ensuring good cosmesis.