Optimizing Myelomeningocele Repair: Assessing the Role of Synthetic Acellular Dermal Regeneration Templates in Complex Closures.

BACKGROUND

Myelomeningoceles threaten newborns with central nervous system infectious risk. While some myelomeningoceles can be repaired fetally, limited donor tissue in newborns makes covering a substantial defect challenging. This study evaluated the effectiveness of acellular dermal regeneration templates (ADRT) in safely healing refractory myelomeningoceles.

METHODS

Seven myelomeningocele repair cases using ADRT (Integra LifeSciences, Plainsboro, NJ) at an academic children's hospital from April 2020 to June 2023 were reviewed. Patients had unsuccessful closure attempts through fetoscopic, postnatal, or revision surgeries by neurosurgery and plastic surgery, leading to complications that required ADRT to protect the dural repair and promote quicker granulation.

RESULTS

The case series included 3 male and 4 female patients, with a median delivery age of 37 weeks (IQR: 33-37). Three underwent fetoscopic repairs, and 4 had postnatal repairs within 48 hours of birth. Six patients required ADRT placement due to failed primary repair. One patient failed fetoscopic closure and required immediate ADRT placement following an emergent cesarean delivery. The median wound size covered was 12 cm 2 (range, 4-20 cm 2 ), and the median hospital stay was 84 days (IQR: 43-105). Three weeks post-ADRT placement, 4 patients showed healthy granulation tissue, and the external silicone layer was removed. Three patients needed additional ADRT for complete wound coverage and successful granulation. After granulation, all wounds eventually epithelialized by secondary intention, with no postoperative infection or wound dehiscence observed.

CONCLUSIONS

ADRT can aid in wound healing and protect dural repair in myelomeningoceles, offering a viable option for complex or failed primary closures with limited donor tissue.