UNILATERAL REVERSE LATISSIMUS-DORSI MUSCLE FLAP FOR POSTOPERATIVE CSFLEAK AND WOUND DEHISCENCE IN LUMBOSACRAL DEFECTS - A LIFEBOAT APPROACH

A lumbosacral defect with cerebrospinal fluid (CSF) leak, particularly after breakdown of a repaired lipomeningomyelocele, is often a diffic ult problem to manage. Although several methods of local flap coverage have been used, local wound infection and tissue cellulitis associate d with the wound dehiscence makes the repair prone to redehiscence, Th e associated CSF leak requires a good reliable closure as a matter of urgency. We describe two patients with lipomeningomyelocele, operated upon for tethered cord syndrome, who developed postoperative CSF leak and wound dehiscence, The associated wound infection and signs of meni ngitis made re-exploration, debridement and a dependable, well vascula rized cover of the dura mandatory. The reverse latissimus dorsi flap p rovided a good vascularized seal. Both patients recovered rapidly. Jou rnal of Clinical Neuroscience (1998) 5(4), 433-435 (C) Harcourt Brace & Co. Ltd 1998