Expansão aguda transoperatória da pele por tração das bordas da ferida para fechamento das mielomeningoceles

AUTOR(ES)

Jose Gilberto de Brito Henriques

DATA DE PUBLICAÇÃO

2008

RESUMO

Skin closure was always the main challenge to the Myelomeningocele (MM) treatment. Most cutaneous defects can be treated with the simple undermining and primary suture of the wound edges. This is the ideal treatment. 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 necrosis occurred 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 a disadvantage. The goal of this technique is not to replace the others, but constitutes an effective option for treatment of large MM.

ASSUNTO(S)

dissertações acadêmicas decs menigomielocele/cirurgia decs disrafismo espinal/cirurgia decs tese da faculdade de medicina da ufmg. anormalidades da pele decs expansao de tecido decs recém-nascido decs cirurgia teses.

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