Abstract: The keystone flap has become an established option
that has been utilized recently to close significant myelomeningocele defects. Although the keystone flaps can be adapted
to repair myelomeningocele defects of different sizes, the shape
of the defect is also an essential factor to consider. In this study,
the authors proposed an algorithmic approach for reconstructing significant meningomyelocele defects utilizing different types
of keystone flaps based on the shape of the resulting defect.
From September 2016 to March 2022, the authors retrospectively reviewed the medical records of 28 patients with
meningomyelocele who underwent repair with the keystone
flaps. The mean age was 28 days (3 days to 4.5 months).
Twenty-one meningomyelocele defects were in the lumbosacral
(75%) and 7 in the thoracolumbar regions (25%).
The defect sizes ranged from 3.5 × 5 cm (area, 13.4 cm2) to
9 × 7 cm (area, 49.5 cm2), with an average of 26.2 cm2. Ten
meningomyelocele defects were a vertically oriented oval shape,
16 defects were a transversely oriented oval shape, and 2 defects
were circular. In addition, unilateral keystone flap was used in
7.1% of the patients (2 patients), bilateral keystone flap in 28.6%
(8 patients), and rotation advancement keystone flaps in 64.3%
(18 patients). According to these findings, an algorithm was
created based on the defect shape.
This algorithmic approach is used as a decision-making
guide to select the correct type of keystone flaps to repair
myelomeningocele according to the defect shape.
Key Words: Algorithm approach, keystone flap, myelomeningocele, reconstruction, rotation advancement keystone flap