Outcomes of myofascial flap closure following complex tethered cord release in pediatric patients

Background: Tethered cord syndrome encompasses a range of neurological deficits resulting from the spinal cord, filum terminale, or nerve roots adhering to the surrounding tissue within the spinal canal. Postoperative complications, such as cerebrospinal fluid leaks or infections, are not uncommon and increase the risk of morbidity and the need for additional surgeries. This study aimed to compare postoperative complications in pediatric patients who received primary wound closure to those who underwent myofascial flap (MFF) closure with plastic surgery following complex tethered cord release (TCR). Methods: We conducted a retrospective review of all pediatric patients who underwent TCR surgery at New York-Presbyterian Weill Cornell Medical Center from 2009 to 2024. Data collected included patient demographics, comorbidities, tethered cord etiologies, surgical approaches, and postoperative outcomes. Student's t-tests, Fisher's exact tests, and backward stepwise Poisson regression were used to compare outcomes between closure techniques and to identify risk factors for postoperative complications. Results: Of the 88 patients with complex tethered cords, MFF closure resulted in significantly fewer total cumulative complications than primary closure. Stepwise Poisson regression identified complex tethered cord etiology and connective tissue disorders as significant risk factors for postoperative complications, with incidence rate ratios of 2.3 and 2.0, respectively. In contrast, MFF closure was associated with a 2.3-fold reduction in total cumulative complications (p < 0.05). Conclusion: MFF closure is a viable alternative to conventional wound closure after TCR in the pediatric population and should be considered in select cases of tethered cord syndrome surgery. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.