Omentum and reverse turnover latissimus dorsi musculocutaneous flap for the treatment of cerebrospinal fluid fistula

Conventional procedures can usually prevent cerebrospinal fluid ( CSF ) leakages, but they may not work for complicated cases. In this case presentation we demonstrated the effectiveness of combined omental and latissimus dorsi musculocutaneous flaps for management of difficult CSF fistula. A reverse turnover latissimus dorsi musculocutaneous flap and omental flap were transferred for reconstruction of the back wound and CSF leakage. The omental flap component was used to CSF absorption and the latissimus dorsi muscle component was used to obliterate the dead space, to cover the exposed bone and for tension-free closure of the wound. The wound healed dramatically. We haven't seen severe donor site morbidity. The patienthas been followed for 30 months with no evidence of CSF leakage and no pseudomeningocele formation which was confirmed by magnetic resonance imaging (MRI) . Although this is a case presentation, we can say that the combination of the omental and musculocutaneous flaps allow effective treatment and prevention of CSF fistulas in selected high-risk patients and provide durable coverage of complex spinal wounds.