Gómez CJ, Cardoso MA, Garavito SE

Language: Spanish
References: 24
Page: 162-168
PDF size: 175.50 Kb.

ABSTRACT

Introduction: Numerous surgical techniques of instrumentation have been described in surgical management of kyphosis in children with myelomeningocele. However, complications related to surgical technique or the soft tissue reconstruction can exist. Tissue expansion is a technique that can be used before spine surgery with damaged skin. Material and Methods: We studied 11 patients with myelomeningocele and kyphosis. All had dural sac closure in neonatal stage as well as thoracic or upper lumbar lesion with severe neurologic deficit. Patients were evaluated by a plastic surgeon that placed a soft tissue expander, as the first stage of reconstruction. Kyphectomy, instrumentation, posterior fusion, expander removal and wound closure were done as a second stage. Results: Fifteen tissue expanders were placed in 11 patients; 4 patients had 2 expanders and 7 patients had one. All the expanders were placed in the back, 9 expanders were placed in thoracic region and 6 in the lumbar region with an average of 17 weeks in the body. No complications were detected in the postoperative period of the tissue expansion. Neurologic deficit was thoracic in 9 patients and upper lumbar in 2 patients; we used for instrumentation ACM plates in 6 patients, SSI with Luque rods in 2 patients, crossed nails in 1 patient, 3.5 DCP in one patient, and we did not use instrumentation in one patient. Four patients (36.3%) had complications related to the kyphectomy and instrumentation in the postoperative period. Conclusions: Use of tissue expanders before the surgical management of kyphosis in myelomeningocele is a good option to avoid complications of soft tissue coverage, evaluation of patients and indications for expanders must be done by a plastic surgeon.

REFERENCES

1. Niall DM, Dowling FE, Fogarty EE, Moore DP, Goldberg C: Kyphectomy in children with myelomeningocele. A long term outcome study. J Pediatr Orthop 2004; 24: 37-44.

2. Sarwark JF: Kyphosis deformity in myelomeningocele. Orthop Clin North Am 1999; 30: 451-5.

3. Martin J Jr, Kumar SJ, Guille JT, et al: Congenital kyphosis in myelomeningocele: Results following operative and nonoperative treatment. J Pediatr Orthop 1994; 14: 323-8.

4. Crawford AC, Strub WM, Lewis R, et al: Neonatal kyphectomy in the patient with myelomeningocele. Spine 2003; 28: 260-6.

5. Guille JT, Sarwark, JF, Sherk, HH, Kumar SJ: Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Ortho Surg 2006; 14: 367-75.

6. Eyring EJ, Wanken JJ, Sayers MP: Spine ostectomy for kyphosis in myelomeningocele. Clin Orthop 1972; 88: 24-30.

7. Lowe GP, Menelaus MB: The surgical management of kyphosis in older children with myelomeningocele. J Bone Joint Surg [Br] 1978; 60: 40-5.

8. Lintner SA, LIndseth RE: Kyphotic deformity in patients who have a myelomeningocele. Operative treatment ad long term follow up. J Bone Joint Surg [Am] 1994; 76: 1301-7.

9. Warner WC Jr, Fackler CD: Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodisplasia. J Pediatr Orthop 1993; 13: 704-8.

10. Cardoso MA, Orellana CA, Rosales ME, Sopalda PN: Pacientes con mielomeningocele y cifosis manejados con placa ACM. Acta Ortopédica Mexicana 2004; 18(3): 86-90.

11. Mc Master MJ: The long term results of kyphectomy and spinal stabilization in children with myelomeningocele. Spine 1988; 13: 417-24.

12. Heydemann JS, Gillespie R: Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation. Spine 1987; 12: 37-41.

13. Thomsen M, Lang RD, Cartens C: Results of kyphectomy with the technique of Warner and Fackler in children with myelodisplasia. J Pediatr Orthop 2000; 9: 143-7.

14. Paonessa KJ, Zide B, Errico T, Engler GL: Using tissue expanders in spinal surgery for deficient soft tissue or post irradiation cases. Spine 1991; 6: S324-S327.

15. Paonessa KJ, Hostnik WJ, Zide B: Use of tissue expanders for wound closure of spinal infections or dehiscense. Orthop Clin North Am 1996; 27(1): 155-70.

16. Arnell K: Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. Acta Neurochir (Wien) 2006; 148(3): 293-297; discussion 297.

17. Radovan C: Tissue expansion in soft tissue reconstruction. Plast Reconstr Surg 1984; 74: 482-90.

18. Manders EK, Schenden MJ, Furrey JA, et al: Soft tissue expansion: Concepts and complications. Plast Reconstr Surg 1984; 74: 493-507.

19. Mustoe TA, Gifford GH, Lach E: Rapid tissue expansion in the treatment of myelomeningocele. Ann Plast Surg 1988; 21: 70-3.

20. Lindseth RE, Stelzer L: Vertebral excision for kyphosis in children myelomeningocele. J Bone Joint Surg Am 1979; 61: 699-704.

21. Ko AL, Song K, Ellenbogen RG, Avellino AM: Retrospective review of multilevel spinal fusion combind with spinal cord transaction for treatment of kyphoscoliosis in pediatric myelomeningocele patients. Spine 2007; 32(22): 2493-501

22. Dogra BB, Sharma A, Singh M, Chakravarty B: Tissue expansion: A simple technique for complex traumatic soft tissue defects. Int Surg 2007; 92(1): 37-45.

23. Elias Dl, Baird WL, Zubowics VN: Applications and complications of tissue expansion in pediatric patients. J Pediatr Surg 1991; 26: 15-21.

24. Gibstein LA, Abramson DL, Bartlett RA, Orgill DP, Upton J, Mulliken JB: Tissue expansion in children: a retrospective study of complications. Ann Plast Surg 1997; 38: 358-64.