Closure of a large myelomeningocele defect using the V–Y rotation advancement flap (butterfly flap): a case report and literature review

Figures & data

Figure 1. A large thoracolumbar meningomyelocele in a newborn.

Figure 2. The rotation flaps are dissected below the muscular fascia level.

Figure 3. A drawing illustration explaining the marking of the V-Y rotation advancement flap. A. The axillary apices marking including most cranial point of the intergluteal sulcus, and posterior axillary lines forming a rectangular field shape. B. Drawing of the transverse dimensions on the wound defect. C. Quadruple flap drawing: the longest diameter of every V-Y rotation, and advancement flap dimension is one and a half more than half of each bisector of the defect. D. V-Y advancement scar after closure as well as the releasing incision scars at the top and bottom of the flaps.

Figure 4. Appearance of the repair at the end of surgery.

Figure 5. The repair 7 days postoperatively.

Table 1. Previously reported methods used in large MMC closure.

Number	First author	Type of study	Country of repair	Sample size	Operative technique	Complications
1.	Desprez [11]	Case series	United States of America	6	Vertical bipedicled	Not mentioned
2.	McCraw [12,14]	Case series	United States of America	5	Bipedicled latissimus dorsi musculocutaneos flaps	Not mentioned
3.	Moore [15]	Case series	United States of America	19	Bipedicled latissimus dorsi musculocutaneous flaps (with lateral relaxing incision)	Not mentioned
4.	Thomas [13]	Case series	Australia	4	Triangular advancement latissimus dorsi. Fasciocutaneous flaps (One or two)	Not mentioned
5.	Cruz [16]	Case series	United States of America	10 (Neonates)	Double Z rhomboid flap	Flap necrosis (n = 1)
6.	Ulusoy [4]	Case series	Turkey	10 (Neonates)	Bilateral modified V-Y advancement flap	Not mentioned
7.	El-sayed [17]	Case series	Egypt	16 (Neonates)	Proximally based fasciocutaneous flank flap	Superficial necrosis (N = 1) CSF leak (n = 1)
8.	Georgeana [18]	Case series	United Kingdom	3 (Children) 2 (Children)	Tissue expansion Advancement local flaps	Not mentioned

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