Expansão aguda transoperatória da pele por tração das bordas da feridapara fechamento das mielomeningoceles

Abstract

Skin closure was always the main challenge to the Myelomeningocele (MM) treatment. Most cutaneous defects can be treated with the simpleundermining and primary suture of the wound edges. This is the idealtreatment. However, this is not the adequate procedure for lesions with more than five centimeters in diameter. Numerous reconstructive procedures have been described with satisfactory results. However, the need to mobilize large skin areas and the excessive blood loss are major problems in newborns. Moreover, the tissue undermining destroys most of the skins vascularization and can harm the adaptation of the skin flaps. This study describes a technique for primary closure of large MM skin defects using acute skin expansion during the surgical procedure. Skin expansion was achieved by wound edges traction with "U" sutures and without the need of skin flaps. Sixteen patients, whose MM were more than five centimeters in diameter, were evaluated. Their MM areas ranged from 30 to 64 cm2 (mean 45 cm2). Two suture systems were developed based on skin edge quality and skin defect size. Wound edges traction was done during periods of ten minutes. A gradual approach of the borders was reached allowing the primary closure without undermining for all of the 16 patients. In one patient skin necrosisoccurred which was associated to compression of the malformed underlying vertebrae. Simplicity, low cost and satisfactory results were the main advantages of the method and an increase in operative time was adisadvantage. The goal of this technique is not to replace the others, butconstitutes an effective option for treatment of large MM.