Two decades of myelomeningocele defect reconstruction: Insights and outcomes from a single center

Numerous reconstruction methods have been developed for myelomeningocele defects; however, no published reports have been published on the preferred reconstruction method in Malaysia. This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center. A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, for wound coverage from to 1997–2023. Data on patient demographics, defect size, reconstruction methods, operation duration, flap-related complications, and secondary repairs were collected and analyzed. Thirteen patients were identified in this retrospective study, comprising 5 female patients, 7 male patients, and 1 ambiguous gender patient. Wound closures were performed using primary closure method, local flaps, or regional flap closure. Nine (69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap, three (23.1%) underwent primary closure, and only one (7.7%) patient underwent wound closure with a regional flap. Flap-related complications were observed in four of the thirteen patients, including wound breakdown in two cases and partial flap necrosis in two cases. Of these four patients, secondary repair was required in three: split-thickness skin grafting was performed in two, and primary closure in one. The remaining patient was managed conservatively with dressings. Patients were followed up for a mean duration of 56.6 (±62.4) months, and complete healing was achieved in all cases. Myelomeningocele repair remains challenging, and a multidisciplinary approach is recommended. We demonstrated various local and regional flap closure methods with good outcomes. Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.