LIMBERG FLAP A BETTER METHOD OF CLOSURE OF LUMBAR MYELOMENINGOCELE DEFECTS: A PROSPECTIVE STUDY

Abstract

Background: Myelomeningocele is the most common and complex congenital malformation of the central nervous system with an incidence of approximately 1 in 1000 live births. The lumbosacral area is the commonest site for defect. Early closure of a myelomeningocele defect is advocated because it reduces infection rates even though it is not associated with an improved neurological outcome. Aims & objectives: The aim of this study was to evaluate the effectiveness and outcome of direct repair and a Limberg ap repair for skin defects that occur in myelomeningocele. Settings and Design: This was a prospective, randomized controlled study. Material and methods: A tertiary care centre based, non-randomized, prospective, comparative study was conducted in the Department of Neurosurgery, GSVM Medical College, Kanpur, from January 2018 to October 2019, in 22 patients with lumbar myelomeningocele. 7 patients who underwent Limberg ap repair constituted Group A and 15 patients who underwent direct repair constituted Group B. Post operatively the outcomes were compared at 6 months, on the basis of cosmetic appearance and complications such as wound dehiscence, CSF leak, neurological decit, hydrocephalus, necrosis and wound infection. Results : Lesser complications and a better cosmetic outcome were seen post operatively at 6 months with Limberg ap technique compared to direct repair. Our study show better result with Limberg ap over direct repair of myelomeningocele defect closure up to the follow up period of 6 months. Conclusion: Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of myelomeningocele defects. Most lumbar myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local aps may be used to cover the defect. Overall, Limberg ap is a better technique for closure in these patients.