Closure of large myelomeningocoele with Ramirez technique

Abstract

Introduction

The authors present their 7-year experience in operative closure of large open myelomeningocoele with a technique introduced by Ramirez et al. in 1986. It consists of medial advancement of bilateral bipedicled musculocutanous flap based on the latissimus dorsi and maximus gluteus without any relaxing incisions or skin grafting.

Results and discussion

Thirty-five babies were operated on according to this technique on first day of life. In 16 cases, large thoracic or thoracolumbosacral defect was noted, while in further 19 newborns, lumbosacral or lumbar defect occurred. The dimensions of the entire defect ranged from 4.8×5 to 8×10.8 cm. In seven babies, the affected area had more than 50 cm². In all patients, three-layer tension-free closure of the dorsal wound was performed in one stage. The mean operative time was 115 min (90–195 min). All but two wounds healed uneventfully. In two babies with wide lumbosacral defects, minor skin necrosis with wound dehiscence was noted which subsequently required conservative treatment. Follow-up period ranges from 6 months to 7 years. In none of the 32 children was any late complication of the reconstructive procedure noted.

Conclusion

Ramirez technique is a very reliable method of closure of myelomeningocoele regardless of the size of the defect and its topography. It may find a wide application in babies affected by neural tube defect.