Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with a large myelomeningocele and kyphosis.

When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation of the skin is a risky venture. Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary epithelialisation. Four of the children had two tissue expanders inserted at the age of 8-12 months; two of them before delayed operation for the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3-7 days during six to eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections, leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal. Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed primary operation thus eliminating the need for extensive musculo-cutaneous flaps.