Soft tissue coverage of delayed presentation of meningomyocele by modified keystone flap

Authors

Keywords:

eystone flap, meningomyelocele, neural tube defect

Abstract

Neural tube defects are congenital abnormalities of neural development with a wide spectrum of clinical manifestations. Meningomyelocele a type of spina bifida , in which the spinal cord and meninges protrude through an opening.

Early surgical interventions are required to reduce the mortality rate by preventing early cerebrospinal fluid leakage and related infections. Simple closures can repair small defects. Simple closure can be challenging in larger defects, leading to wound dehiscence and subsequent cerebrospinal fluid leakage. This case report discusses the successful use of modified keystone flap repair for large lumbosacral meningomyelocele defects.

We report the 18th day of life, term female baby with lumbosacral meningomyelocele, who underwent neural placode reduction with repair of dura followed by modified keystone flap repair to achieve adequate neural closure and prevent subsequent infection. The flap preserved vascularity and decreased the need for complex grafts and revision surgery with no sign of flap necrosis, fistula, or cerebrospinal fluid leakage.

This case highlights that modified keystone flap repair is a safe, simple, successful, and versatile technique that can be used to cover large meningomyelocele defects.

Author Biographies

Piyush Giri, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

Assistant Professor (Plastic Surgery), Department of Surgery, Western Regional Hospital

Sushant Rai, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

Plastic Surgeon, Department of Surgery, Western Regional Hospital

Karuna Khadka, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MBBS Intern, Department of Surgery, Western Regional Hospital

Sushma Kunwar, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MBBS Intern, Department of Surgery, Western Regional Hospital

Pratishtha Panday, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MBBS Intern, Department of Surgery, Western Regional Hospital

Shrinkhala Pokhrel, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MBBS Intern, Department of Surgery, Western Regional Hospital

Ana Rosa Teixiera Roberto, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MBBS Intern, Department of Surgery, Western Regional Hospital

Ashok Gautam, Pokhara Academy of Health Sciences, Pokhara, Kaski, Nepal

MS Resident, Department of Surgery, Western Regional Hospital

https://doi.org/10.3126/jpahs.v11i3.80187

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Published

2025-06-19

How to Cite

Giri, P., Rai, S., Khadka, K., Kunwar, S., Panday, P., Pokhrel, S., … Gautam, A. (2025). Soft tissue coverage of delayed presentation of meningomyocele by modified keystone flap. Journal of Patan Academy of Health Sciences, 11(3), 23–26. Retrieved from https://jpahs.edu.np/index.php/jpahs/article/view/404