Surgical repair of large meningomyeloceles

Successful repair of 8 large meningomyeloceles is reported. Because these defects varied in size, shape, and location, no single procedure applied to all. Advancement flaps and both vertical and horizontal bipedicle flaps were used successfully. The latissimus dorsi and gluteus maximus muscles have been used as paired flaps. All four muscles can be mobilized simultaneously. Muscle flaps are preferable to skin flaps when feasible. The sac remnant is also available to contribute to closure when all else fails. Embryology and pathological anatomy are reviewed.