**Surgical Treatment of Large Thoraco-Lumbar Neural Tube Defects**

190 Neural Tube Defects – Role of Folate, Prevention Strategies and Genetics

van der Linden, I., Afman, L., Heil, S., & Blom, H. (2006). Genetic variation in genes of folate

Whetstine, J., Gifford, A., Witt, T., Liu, X., Flatley, R., Norris, M., Haber, M., Taub, J.,

*Clinical Cancer Research* Vol. 7, pp3416–3422, ISSN: 1078-0432.

pp204–21, ISSN: 0029-6651.

metabolism and neural-tube defect risk. *Proceedings of the Nutrition Society* Vol.65,

Ravindranath, Y., & Matherly, L (2001). Single Nucleotide Polymorphisms in the Human Reduced Folate Carrier: Characterization of a High-Frequency G/A Variant at Position 80 and Transport Properties of the His27 and Arg27 Carriers.

**11** 

*Iran* 

**Treatment of Large** 

*Kashan University of Medical Sciences* 

Mehrdad Hosseinpour

*Pediatric Surgeon* 

 **Thoraco-Lumbar Neural Tube Defects** 

Myelo-meningocele (MMC) is the most complex congenital malformation of the CNS that is compatible with life .Although the incidence of the MMC is decreasing, it remains one of the most common birth defect of the central nervous system, with an incidence of 0.5 to 1 per 1000 pregnancies in the USA and higher in some other part of the world, particularly developing countries.An MMC is typically closed within 24-48 hours after birth, and the goal of surgery is to close the neural placode in to a neural tube to establish a micro

Although MMC closure consist of the soft tissue and skin adjacent to be the defect, but repair of MMC larger than 5 cm in diameter is almost never easy. For this reason, increasing

In 1956, Soderby and Sutton described the repair of MMC defect by plastic surgery. Desprez in 1971 reported the use of composite skin – muscle flaps for closure of large MMC. In 1977, Nelson described the use of delayed bipedicle flaps. In the same year, David and Adendorff used a large rotation flap raised across the midline MMC. In 1978, McGraw firstly described use of a posterior – advancement Lattissimus dorsi,

In this chapter, we review the repair of large MMC defects by several methods described

The fasciacutaneous flap closure is supported by a rich vascular network with three main

1. A prominent transverse segmental vascular pattern originating from the muscular

perforator and lateral cutaneous branches of the lower intercostal arteries. 2. The parascapular and scapular fascial branches of the circumflex scapular artery.

3. Lateral extension of the superficial circumflex iliac arteries.

attention has been directed at soft tissue closure with multiple anatomic layers .

**1. Introduction** 

environment conductive to neural function.

myocutaneos flap to repair MMC.

**2. Skin and fasiocutaneous flaps 2.1 Bilateral fasciocutaneous flap** 

dominant vascular territories as bellow:

recently in literature.
