Tension free closure of large meningomyelocele defects

A technique for closing large meningomyelocele defects without tension has recently been developed by the authors. The technique utilizes bilateral bipedicle flaps developed from verticle flank incisions. The bipedicle flaps are advanced medially and approximated in the midline. The lateral defects created by this maneuver are closed transversely. The outer margins of the bipedicle flaps are left free until the flaps become adherent to the underlying tissue. This technique has been used in the repair of 12 large meningomyeloceles. The width of the average lesion was 6-7 centimeters, the largest lesion was 11 centimeters. In each case the width of the lesion exceeded one-half the width of the back. In all cases a tension free closure was achieved. There were no significant wound complications. The use of this technique has greatly facilitated the treatment of children with large meningomyelocele defects.