Comparative analysis of bipedicled fasciocutaneous flaps in meningomyelocele repair: influence of perforator preservation on postoperative outcomes and hospitalization duration

Abstract

Purpose Meningomyelocele (MMC), a severe congenital defect of the central nervous system, is commonly associated with high morbidity and mortality. Surgical closure of MMC is essential to prevent infection, cerebrospinal fluid leakage, and nerve damage. In cases with large defects, flap surgery is required. This study examines whether preserving musculocutaneous perforators which enters to the flap itself during the repair with bipedicle fasciocutaneous flaps improves outcomes compared to flaps without perforator preservation. Methods We retrospectively analyzed 79 MMC patients who underwent repair with bipedicle fasciocutaneous flaps from January 2013 to December 2022. Patients were divided into two groups: Group 1 (perforators not preserved) and Group 2 (perforators preserved). We evaluated flap perfusion, complications, operation time, hospital stay, and discharge readiness. Results Results showed that Group 2 had a lower incidence of early postoperative venous insufficiency (15.2% vs. 34.29%, p < 0.05), partial flap necrosis (4.55% vs. 11.43%, p < 0.05), wound dehiscence (6.82% vs. 22.86%, p < 0.05), and secondary surgeries (13.64% vs. 25.71%, p < 0.05). Group 2 patients were ready for discharge significantly sooner (6.93 days vs. 9.26 days, p < 0.05). No significant differences were observed in operation time or blood loss between the groups. Conclusion Preserving perforators in bipedicle fasciocutaneous flaps enhances flap viability, reduces complication rates, and shortens hospital stays. This technique should be adopted for MMC repairs to improve clinical outcomes.