Newborn Myelomeningocele Closed Using U-Shaped Sutures: A Case Report

Abstract

Introduction: Myelomeningocele (MMC) is a common neural tube defect. Skin closure for MMC repair is challenging, and the surgical approach remains controversial, particularly in cases of MMC accompanied by severe kyphosis and large skin defects. We describe MMC in a newborn and discuss the surgical procedure of skin closure in this patient.

Case Report: A full-term female neonate born by caesarean delivery was diagnosed with hydrocephalus on fetal ultrasonography at 28 weeks of gestation and was referred to our hospital. Fetal magnetic resonance imaging revealed MMC at the thoracolumbar region, gibbus apex, cerebellar deformity, and hydrocephalus. She was born by caesarean delivery at 38 weeks' gestation and weighed 2,892 g with head circumference of 34.5 cm (+1.1 standard deviation) at birth. Clinically, she presented with MMC measuring 50×62 mm in size, bilateral club feet, and severe spinal kyphosis. No other congenital anomalies were detected, and she underwent MMC closure surgery at 2 days of age. Based on the extent of kyphosis and skin defect, we concluded that the skin defect did not need skin flap closure. After closure of the neural duct, we performed U-shaped sutures for skin closure. The skin was retracted using U-shaped sutures thrice intermittently and was closed during a single operative procedure. The patient showed no complications associated with wound closure, 6 months postoperatively.

Conclusions: U-shaped sutures used for MMC skin closure ensure complete preservation of the subcutaneous tissue without massive blood loss or invasion, which serves as an advantage of this approach, particularly in newborns with vulnerable skin. U-shaped sutures may be useful for closure of skin defects >50 mm in size, without major operative complications. We report the case of a neonate with MMC who underwent successful skin closure using U-shaped sutures.