Role of Perforator Flaps in Back Defects Reconstruction

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-31

Study Completion Date

2026-05-31

Brief Summary

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evaluation of perforator flaps versus perforator plus flaps

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Detailed Description

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One of the neural tube defects, myelomeningocele, is a congenital anomaly developing in the fourth gestational week. It is characterized by insertion of neural elements into a pouch floored by meninx through a vertebral defect.

The aetiology is multifactorial. causes are genetic properties, geographic factors, and deficiency of folic acid.

Meningomyelocele incidence range between 1 and 2/1000 live births. The defect location can reside anywhere between the cervical region and the sacrum.

surgical closure of the defect is performed to prevent cerebrospinal fluid leakage and central nervous system infections. it is a combined work between neurosurgery and plastic surgery. Fascial turnover flaps, muscle flaps, local fasciocutaneous flaps.

With the emerging concepts of perforator flaps in the last three decades, the reconstruction of myelomeningocele defects has completely changed since the anatomy of the dorsal intercostal artery perforators (DIAP) and lumbar artery perforators(LAP) has been fully studied.

Despite utilizing perforator flaps having greatly improved the outcome of myelomeningocele reconstruction, venous compromise remained a major concern associated with complications.

By preserving, the perforator vessels and minimizing the amount of tissue that is removed, the Perforator Plus technique can improve blood flow and decrease the risk of venous congestion.

Preoperative perforator mapping may be executed by a multitude of diagnostic modalities. Hand-held Doppler (HHD), color-coded duplex sonography (CCDS), computed tomography angiography (CTA), magnetic resonance angiography (MRA) and others may be applied.

Systematic reviews of the literature revealed that CCDS has the highest sensitivity and positive predictive value to identify perforators for flaps.

Conditions

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Myelomeningocele

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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closure of the myelomeningocele defect by perforator flap.

fifteen patient with myelomeningocele defect

Group Type EXPERIMENTAL

surgical closure of myelomeningocele defects by perforator flaps

Intervention Type PROCEDURE

closure of myelomeningocele defect by perforator island flap after complete incision of the flap all around based on perforator vessel .

closure of the myelomeningocele defect by perforator plus flap .

fifteen patient with myelomeningocele defect

Group Type EXPERIMENTAL

surgical closure of myelomeningocele defects by perforator-plus flaps

Intervention Type PROCEDURE

closure of myelomeningocele defect by perforator-plus island flap harvesting leaving skin bridge connecting to the flap and dissection of the perforator vessel

Interventions

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surgical closure of myelomeningocele defects by perforator flaps

closure of myelomeningocele defect by perforator island flap after complete incision of the flap all around based on perforator vessel .

Intervention Type PROCEDURE

surgical closure of myelomeningocele defects by perforator-plus flaps

closure of myelomeningocele defect by perforator-plus island flap harvesting leaving skin bridge connecting to the flap and dissection of the perforator vessel

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* infants up to one year,
* dorso-lumbar myelomeningocele.
* moderate to large myelomeningocele defects. (25 - 39 cm2 ) .

Exclusion Criteria

* cervical myelomeningocele
* very large defects (more than 40 cm2 )
* preterm newborn patients.
* hematological disease
* any problem against prone position of the patient

Minimum Eligible Age

2 Days

Maximum Eligible Age

1 Year

Eligible Sex

ALL

Accepts Healthy Volunteers

No