Propellers Flaps for Meningomylocele Defects

Study Overview
=================
Brief Summary
-----------------
To evaluate reliability of free style propeller perforator flap for coverage MMC soft tissue defect follow a well-established step that overcome the usual problem of pedicled perforators propellers flaps.

Detailed Description
-----------------
Meningomyelocele is a serious congenital birth defect that not only affect mortality and morbidity of neonate but also a lifelong health problem. The estimated incidence of spina bifida is 1-2 cases per 1000 population. Meningomylocele soft tissue defect reconstruction is considered a lifesaving procedure , the ideal coverage technique should be time limited , reliable and allow healing line to be away from repair of the dura . all of these criteria are available in the selection of free style propeller perforator flap as a method of reconstruction.

Official Title
-----------------
Free Style Pedicled Perforators Propellers Flaps for Meningomylocele Defects Reconstruction With Sequential Advance in Perforators Dissection

Conditions
-----------------
Meningocele, Meningomyelocele

Intervention / Treatment
-----------------
* Procedure: Freestyle pedicled perforators propellers flaps for meningomyelocele defects


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All cases with dorsolumbar meningomyelocele and age up to 6 months Exclusion Criteria: Infants older than 6 months concomitant congenital anomalies concomitant spinal kyphosis

Ages Eligible for Study
-----------------
Minimum Age: 1 Day
Maximum Age: 6 Months

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dorsal intercostal artery (DICA) perforator flaps<br>Retrograde dissection of free style perforator arising from DICA according to region of dorsal spine and identification of paraspinal muscle where perforator vessel was found | Procedure: Freestyle pedicled perforators propellers flaps for meningomyelocele defects<br>* Freestyle pedicled perforators propellers flaps for meningomyelocele defects reconstruction with sequential advance in perforators dissection, large number cases, and detailed successful technique.<br>|
| Experimental: Trapezius musculocutaneous perforator flaps<br>Retrograde dissection of a free style perforator arising as a trapezius myocutenous perforator where the trapezius muscle is identified and a perforator vessel was isolated. | Procedure: Freestyle pedicled perforators propellers flaps for meningomyelocele defects<br>* Freestyle pedicled perforators propellers flaps for meningomyelocele defects reconstruction with sequential advance in perforators dissection, large number cases, and detailed successful technique.<br>|
| Experimental: Lumbar artery perforators flaps<br>Retrograde dissection of free style perforator arising from lumbar artery according to region of lumbar spine and identification of lumbar fascia where perforator vessel was found | Procedure: Freestyle pedicled perforators propellers flaps for meningomyelocele defects<br>* Freestyle pedicled perforators propellers flaps for meningomyelocele defects reconstruction with sequential advance in perforators dissection, large number cases, and detailed successful technique.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of reconstruction technique | Measure the average operative time in minutes in each arm. | Time of procedure | 
| Pedicle dissection beyond the muscle | Compare the number of pedicle dissection beyond the muscle in each group. | Time of procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Meningomyelocele Repair Dehiscence and/or CSF leak | Compare the number of each complication in each arm | Time of procedure | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Reconstructive Surgical Procedures / adverse effects, Meningomyelocele / surgery