Use of Allogenous Material in the Management of Spina Bifida Aperta

Česká verzia

Authors: P. Omaník; F. Horn; M. Smrek; I. Béder; E. Murár; J. Trnka; V. Cingel
Authors place of work: Klinika detskej chirurgie DFNsP a LF UKo, Bratislava, Slovenská republika, prednosta: MUDr. Ján Trnka, CSc.
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 10, s. 527-530.
Category: Monothematic special - Original

Summary

Aim:
“Conditio sine qua non“ in the management of open neural tube defects includes closure of all layers with as minimum as possible tension left within the suture region, in order to prevent early, as well as long-term postoperative complications. In extensive fascial defects, the authors used the Gore-Tex patch as an alternative to myofascial or fasciocutaneous flaps.

Patients and Methods:
From January 2004 to January 2008, 23 patients suffering from open spina bifida underwent surgery in the Bratislava Pediatric Surgery Centre. In 17 subjects, the fascia was sutured following a myofascial release, in 2 subjects the suture was secured with tissue adhesive. In 4 subjects, the Gore-Tex patch was implanted to secure the „tension free“ plasty; the Gore-Tex Dual Mesh was used in 2 subjects as well as the Gore-Tex Spinal.

Results:
Two subjects, who had the Gore-Tex Dual Mesh implanted, developed sequestration of the implant during the late postopertive period. Upon reoperation, the authors removed the Gore-Tex Dual Mesh in the both subjects. However, they found a firm fibrous membrane, which was considered sufficient to protect the dural sac. On the contrary, the both subjects who had the Gore-Tex Spinal implanted, healed with no complications recorded.

Conclusion:
Based on the experience, the Gore-Tex Dual Mesh, although implanted lege artis, does not appear a suitable material for fascia replacements in open spina bifida plastic procedures. Further experience will give more evidence, whether Gore-Tex Spinal would be a suitable alternative, however, the courses in the 2 subjects have hitherto been encouraging.

Key words:
neural defects – spina bifida, Gore-Tex – reconstruction/plasty – complications

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