A new approach to closure of large lumbosacral myelomeningoceles: The superior gluteal artery perforator flap

We believe the superior gluteal artery perforator flap represents a useful tool in the management of soft-tissue defects associated with large lumbosacral myelomeningoceles. The procedure allows for the transfer of healthy, vascularized tissue over the dural closure, likely diminishing both cerebrospinal fluid leaks and cerebrospinal fluid infections. Because the dural repair is covered with well-padded tissue using this flap, we are hopeful that this approach will diminish the chronic pain at the closure site that many of these patients have later in life. Although we are hopeful that this approach might also diminish the rate of symptomatic tethered cord, it will be many years and require many more patients before that question is definitively answered. The procedure is technically challenging and should be performed by individuals with significant experience with this patient population.