DOUBLE ROTATION FASCIOCUTANEUS FLAP COVER FOR LARGE LUMBOSACRAL MENINGOMYELOCELE

Meningomyelocele (MMC) is the most common form of spinal dysraphism. Closure of the meningomyelocele defect is a challenge and a variety of reconstructive options are described. Closure of the MMC is critical to prevent infection and neurological deterioration. Twenty five percent of the defects are wide defects which cannot be closed primarily. Meningomyelocele defects in the lower sacral area are more difficult to close than defects in the thoraco-lumbar area because the latissimus muscle is anatomically insufficient to provide total muscular coverage of the meninges in the sacral area. In a case of 4 month old baby with large Meningomyelocele, a double rotation fasciocutaneous flap with a minor modification to usual double rotation was applied for easy tension free closure of the defect and primary closure of the secondary defect. The vertical distal ends of the defect were closed primarily thus reducing the defect size and consequently a much smaller flap could be designed. A tension free easy closure in a short duration with less bleeding is the advantage of this technique.