Comparing longitudinal and transverse wound closure methods for spina bifida

Spina bifida, a neurological disorder affecting approximately 1 in 1,000 births worldwide, is the most severe form of myelomeningocele, often causing significant neurological disabilities. Early surgical intervention is required to decrease the risk of infection and prevent further tissue damage. This study aims to compare longitudinal and transverse wound closure methods, focusing on their impact on healing, scarring, and revision rates to improve patients’ quality of life and reduce healthcare burdens. This prospective cohort study included 48 neonates with myelomeningocele requiring surgical closure. Closure technique (longitudinal or transverse) was determined by intraoperative assessment of the defect size, shape, and available skin tissue, rather than randomized allocation. Healing time, infection rate, cerebrospinal fluid (CSF) leakage, and scar formation were evaluated using standardized scales. Patients requiring urgent ventriculoperitoneal (VP) shunting were not excluded to maintain clinical representativeness. The study involved 48 patients, predominantly female (58.3%), aged between 2 to 14 days, with 66.7% presenting within the first 6 days. All patients exhibited myelomeningocele lesions, primarily in the thoracolumbar region (62.5%). Surgical results showed that despite longitudinal closure techniques significantly reduced both operative time (2.5 h versus 3.0 h) and healing time (4 weeks versus 6 weeks) compared with a transverse technique, there was a lower infection rate in the longitudinal group (4.2% versus 25.0%), as were cerebrospinal fluid leakages (8.3% vs. 20.8%). The assessment of Scar visibility was significantly better in the longitudinal group (1.2 vs. 3.5), with 100% achieving satisfactory wound healing compared with 75% in the transverse group. The longitudinal wound closure techniques are the preferred approach in spina bifida repair clinical guidelines for pediatric neurosurgery. Future research should emphasize assessing long-term effects on neurological function, quality of life, and patient satisfaction.