Unilateral reverse latissimus dorsi muscle flap for postoperative CSF leak and wound dehiscence in lumbosacral defects: a lifeboat approach

A lumbosacral defect with cerebrospinal fluid (CSF) leak, particularly after breakdown of a repaired lipomeningomyelocele, is often a difficult problem to manage. Although several methods of local flap coverage have been used, local wound infection and tissue cellulitis associated with the wound dehiscence makes the repair prone to redehiscence. The associated CSF leak requires a good reliable closure as a matter of urgency. We describe two patients with lipomeningomyelocele, operated upon for tethered cord syndrome, who developed postoperative CSF leak and wound dehiscence. The associated wound infection and signs of meningitis made re-exploration, debridement and a dependable, well vascularized cover of the dura mandatory. The reverse latissimus dorsi flap provided a good vascularized seal. Both patients recovered rapidly.