ANATOMIC STUDIES AND CLINICAL-EXPERIENCE WITH FASCIOCUTANEOUS FLAP CLOSURE OF LARGE MYELOMENINGOCELES

Thirteen patients have undergone reconstruction of large lumbosacral m yelomeningoceles with bilateral paralumbar fasciocutaneous flaps. Fasc iocutaneous flap closure is supported by a rich vascular network with three main dominant vascular territories. In the middle third of the f laps, a prominent transverse segmental vascular pattern originating fr om the muscular perforators and lateral cutaneous branches of the cost al groove segment of the lower intercostal arteries was noted. The par ascapular and scapular fascial branches of the circumflex scapular art ery supplied the upper lateral portion of the flaps. Prominent lateral extensions of the superficial circumflex iliac arterial system formed the dominant fascial vasculature of the lower lateral flap, richly ar borizing with the middle segmental intercostal extensions. All 13 pati ents tolerated the procedure without blood transfusion and without per ioperative complications. Stable, durable cutaneous coverage was achie ved in all patients. Two postmortem neonate humans with large lumbosac ral myelomeningoceles were studied angiographically. Radiopaque silico ne-rubber-lead-chrome matrix (Microfil) was infused under physiologic pressures in a 7-day neonate after successful defect closure with bila teral fasciocutaneous flaps. The flaps were reevaluated postmortem, an d high-contrast, digitally enhanced computed radiographic imaging conf irmed the rich vascular support of the bilateral fasciocutaneous flaps , identifying the dominant vascular pedicles. Rich vascularity was fur ther documented by photographing the orange opaque Microfil cast vesse ls through the reelevated flaps. A second postmortem (stillborn) myelo meningocele specimen was studied with barium infusion with particular emphasis on the anomalous lumbar aorta. Angiographic studies provide a new understanding of the unique vascular anatomy of both the anomaly and the paralumbar fasciocutaneous flap.