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evaluation of perforator flaps versus perforator plus flaps
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| closure of the myelomeningocele defect by perforator flap. | Experimental | fifteen patient with myelomeningocele defect |
|
| closure of the myelomeningocele defect by perforator plus flap . | Experimental | fifteen patient with myelomeningocele defect |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| surgical closure of myelomeningocele defects by perforator flaps | Procedure | closure of myelomeningocele defect by perforator island flap after complete incision of the flap all around based on perforator vessel . |
| Measure | Description | Time Frame |
|---|---|---|
| changing complication rate | evaluate of different flaps modalities in back defects closure | baseline and 3 months |
| changing hospital stay time | baseline and one month |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| mohamed tawfik, doctor | Contact | 01029980167 | mtawfik206@aun.edu.eg | |
| Osama taha, professor | Contact | 01069468684 | osamataha@osamataha.health |
| Name | Affiliation | Role |
|---|---|---|
| mahmoud Abdelaal, doctor | professor | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21301309 | Background | Isik D, Tekes L, Eseoglu M, Isik Y, Bilici S, Atik B. Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap. Ann Plast Surg. 2011 Aug;67(2):159-63. doi: 10.1097/SAP.0b013e3181f3e0cf. | |
| 24918736 | Background | Cologlu H, Ozkan B, Uysal AC, Cologlu O, Borman H. Bilateral propeller flap closure of large meningomyelocele defects. Ann Plast Surg. 2014 Jul;73(1):68-73. doi: 10.1097/SAP.0b013e31826caf5a. |
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| ID | Term |
|---|---|
| D008591 | Meningomyelocele |
| ID | Term |
|---|---|
| D009436 | Neural Tube Defects |
| D009421 | Nervous System Malformations |
| D009422 | Nervous System Diseases |
| D000013 | Congenital Abnormalities |
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| surgical closure of myelomeningocele defects by perforator-plus flaps | Procedure | closure of myelomeningocele defect by perforator-plus island flap harvesting leaving skin bridge connecting to the flap and dissection of the perforator vessel |
|
| 26010351 | Background | Basterzi Y, Tenekeci G. Dorsal Intercostal Artery Perforator Propeller Flaps: A Reliable Option in Reconstruction of Large Meningomyelocele Defects. Ann Plast Surg. 2016 Apr;76(4):434-7. doi: 10.1097/SAP.0000000000000417. |
| 32110822 | Background | Kehrer A, Heidekrueger PI, Lonic D, Taeger CD, Klein S, Lamby P, Sachanadani NS, Jung EM, Prantl L, Batista da Silva NP. High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction. J Reconstr Microsurg. 2021 Jan;37(1):75-82. doi: 10.1055/s-0040-1702162. Epub 2020 Feb 28. |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |