{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:15:35Z","timestamp":1789024535116,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>During <jats:italic>in\u2010utero<\/jats:italic> spina bifida (SB) repair, closure of large defects is often challenging, requiring tissue graft for watertight skin closure. No prior studies have compared primary skin closure <jats:italic>vs<\/jats:italic> patch\u2010based repair. Our objective was to compare neonatal and 1\u2010year outcomes associated with these two types of skin closure for <jats:italic>in\u2010utero<\/jats:italic> SB repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study of 102 patients undergoing open prenatal SB repair from September 2011 to August 2021 at a single institution. All patients met the inclusion criteria of the Management of Myelomeningocele Study (MOMS), and the surgical procedure for <jats:italic>in\u2010utero<\/jats:italic> SB repair was similar to that described in the MOMS trial. During the surgery, if primary skin approximation was not feasible due to the large size of the defect, the decision was at the discretion of the pediatric neurosurgeon to utilize a patch for closure. Neonatal outcomes at birth and 1\u2010year outcomes were compared between the primary skin and patch\u2010based closure groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 102 patients included in the study, 70 (68.6%) underwent primary skin closure and 32 (31.4%) patch\u2010based closure. The patch type included acellular bovine skin matrix (Durepair\u00ae; <jats:italic>n<\/jats:italic>\u2009=\u200931) and human acellular dermal matrix (Alloderm\u00ae; <jats:italic>n<\/jats:italic>\u2009=\u20091). Fetuses with myeloschisis were more likely to require patch\u2010based repair than those with myelomeningocele. The median time of fetal repair was 4\u2009min longer for patch\u2010based compared with primary skin closure (37 <jats:italic>vs<\/jats:italic> 33\u2009min; <jats:italic>P<\/jats:italic>\u2009=\u20090.001). Following patch\u2010based repair, neonates had a longer length of stay in the neonatal intensive care unit (NICU) by 24\u2009days (adjusted risk ratio, 2.40 (95%\u2009CI, 1.41\u20134.29)) compared to those that underwent primary skin closure. There was no difference between the two groups in the other neonatal outcomes, including the need for ventriculoperitoneal shunt placement and cerebrospinal fluid leakage. Outcome at 1\u2009year of age was available for 90 infants. Need for wound revision within their first year after birth was more common in infants who underwent patch\u2010based <jats:italic>vs<\/jats:italic> those with primary skin closure (19.4% <jats:italic>vs<\/jats:italic> 5.1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.05). There was no difference between the two groups in other 1\u2010year outcomes, including the need for ventriculoperitoneal shunt placement by 1\u2009year of age and surgery for tethered cord.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patch\u2010based closure during SB repair is often needed in fetuses with myeloschisis and is associated with prolonged fetal surgery time, long NICU stay and need for wound revision within the first year after birth. Further studies are required to identify optimal patches for SB repair or alternative methods to improve outcome. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26018","type":"journal-article","created":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T17:39:16Z","timestamp":1656178756000},"page":"666-672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Primary <i>vs<\/i> patch\u2010based skin closure for <i>in\u2010utero<\/i> spina bifida repair"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4715-566X","authenticated-orcid":false,"given":"M.","family":"Fishel Bartal","sequence":"first","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6276-854X","authenticated-orcid":false,"given":"E. P.","family":"Bergh","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Tsao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. T.","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"K. J.","family":"Moise","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Garnett","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Mann","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Hernandez\u2010Andrade","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3801-346X","authenticated-orcid":false,"given":"R.","family":"Papanna","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School The University of Texas Health Science Center at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_7_3_1","first-page":"e164","article-title":"Committee Opinion No. 720: Maternal\u2013Fetal Surgery for Myelomeningocele","volume":"3","author":"Committee on Obstetric Practice SMFM","year":"2017","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_4_1","article-title":"Management of Myelomeningocele Study I. 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