Long-term follow-up of keystone perforator island flap in reconstructed myelomeningocele defects.

ABSTRACT

Myelomeningocele (a type of spina bifida) is the most common congenital condition that causes lifelong physical disability and requires multi-system surgical procedures. Therefore, it is paramount to reconstruct them using a stable and robust method that heals with minimal wound issues and produces maximum durability. We published a case series on reconstruction of myelomeningocele defects using keystone perforator island flap in the Annals of Plastic Surgery in 2016.1 We aim to report the results of long-term follow-up of 14 years on our case series, where we assessed their scars using POSAS 3.0. We also assessed their quality of life using the QUALAS tool for teenagers. While there are multiple reconstructive options for the closure of myelomeningocele defects, we believe that the keystone perforator island flap technique is reliable and safe as it utilizes the en bloc movement of a large flap of well-vascularized skin, cutis, and muscular fascia to close large defects in the lumbar-sacral regions in newborns, resulting in stable scars.2-7.