Okamoto et al identified risk factors for skin breakdown in patients with myelomeningocele. Compensating for these problems can reduce the risk of pressure ulceration. The authors are from the University of Washington and Children's Orthopedic Hospital in Seattle, Washington.


Skin injury is common in patients with myelomeningocele and may include:

(1) dermatitis

(2) abrasions

(3) lacerations

(4) decubiti


Risk factors for skin breakdown:

(1) incontinence-associated dermatitis (stool and/or urine)

(2) excessive pressure, including asymmetrical weight-bearing

(3) excessive shear forces, including excessive motor activity

(4) mental retardation

(5) large head size (? hydrocephalus)

(6) kyphoscoliosis or kyphosis

(7) rubbing or pressure from an orthotic device or plaster cast

(8) high paraplegia

(9) skin anesthesia (high sensory impairment)

(10) joint deformity

(11) abnormal neurologic examination of the upper extremities

(12) poor compliance by family with management instructions


The risk of skin breakdown can be reduced by:

(1) educating the patient and family

(2) proper fitting of orthoses, casts and shoes

(3) frequent exams, with prompt attention to any skin problem

(4) management of incontinence

(5) pressure reliefs

(6) symmetrical weight-bearing

(7) identification and removal of factors causing skin damage


To read more or access our algorithms and calculators, please log in or register.