case_images: PMC8409962_01
case_images: A large thoracolumbar meningomyelocele in a newborn.
case_images: ICRP_A_1971528_F0001_C.jpg
case_images: PMC8409962_01_ICRP_A_1971528_F0001_C.jpg
case_images: F0001
case_images: A 5-day-old male neonate was delivered at 35 weeks of gestation via cesarean section at our institute, King Saud Medical City in Riyadh, Saudi Arabia, who had several congenital defects involving skeletal dysplasia, hydrocephalus, meningoencephalocele, and thoracolumbar MMC at the T6-L2 level (Figure 1).
case_images: The rotation flaps are dissected below the muscular fascia level.
case_images: ICRP_A_1971528_F0002_C.jpg
case_images: PMC8409962_01_ICRP_A_1971528_F0002_C.jpg
case_images: F0002
case_images: The dissection limit to increase the flaps was demarcated by a line across the patient's back through the most cranial point of the intergluteal sulcus and a second line connecting the axillary apices (Figure 2).
case_images: 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.
case_images: ICRP_A_1971528_F0003_C.jpg
case_images: PMC8409962_01_ICRP_A_1971528_F0003_C.jpg
case_images: F0003
case_images: To achieve tension-free closure over the center of the MMC, releasing incisions were made at the top and bottom of the flaps (Figure 3).
case_images: Appearance of the repair at the end of surgery.
case_images: ICRP_A_1971528_F0004_C.jpg
case_images: PMC8409962_02_ICRP_A_1971528_F0004_C.jpg
case_images: F0004
case_images: The flap presented adequate perfusion postoperatively with a good capillary refill, without changes in color (cyanosis or pallor) (Figures 4 and 5).
case_images: PMC8409962_02
case_images: Appearance of the repair at the end of surgery.
case_images: ICRP_A_1971528_F0004_C.jpg
case_images: PMC8409962_02_ICRP_A_1971528_F0004_C.jpg
case_images: F0004
case_images: The flap presented adequate perfusion postoperatively with a good capillary refill, without changes in color (cyanosis or pallor) (Figures 4 and 5).
case_images: The repair 7 days postoperatively.
case_images: ICRP_A_1971528_F0005_C.jpg
case_images: PMC8409962_02_ICRP_A_1971528_F0005_C.jpg
case_images: F0005
case_images: The flap presented adequate perfusion postoperatively with a good capillary refill, without changes in color (cyanosis or pallor) (Figures 4 and 5).