Neonatal Myelomeningocele/Myeloschisis Clinical Pathway — ICU
Neonatal Myelomeningocele/Myeloschisis Clinical Pathway — ICU
Wound and Scar Management
Wound Care for Prenatal Closure
Alloderm Patch
In general, infants born with an exposed patch will have wet to dry dressing changes with sterile gauze three times a day to optimize healing. Wet to dry dressings promote healing through granulation and epithelialization. Please have neurosurgery evaluate before initiating wound care.
Wound Care for Postnatal Closure
Pre-operatively
- Maintain continuous normal saline drip to myelomeningocele pre-operatively.
- Wet gauze only to clean diaper area.
- Please refer to the continuous normal saline drip and post-operative surgical dressing nursing procedure.
Post-operatively
- Perform Johnson & Johnson washes as ordered.
- Place post-operative dressing of clean gauze over closure site with cut Mepilex border to help prevent stool contamination as pictured below.
- Change daily or with ordered Johnson & Johnson washes and PRN when soiled
- This Mepilex border dressing is usually not needed for home
- Following the Diaper Dermatitis/Perineal Skin Care Guidelines
- Please also use cleansing spray and wet gauze for cleaning the diaper area
- Apply a thick layer of HydraGuard or Desitin over the diaper area +/- an outer layer of Adapt powder to help prevent skin breakdown
Scar Massage
- For fetal closure patients, scar message can usually begin in the N/IICU if the closure site is well healed. PT and/or neurosurgery usually teach scar massage
- For postnatal closures, scar massage does not usually begin until after the first outpatient appointment with neurosurgery