Answer:
The majority of open meningomyelocoele defects are small enough so that soft tissue closure is achieved with simple undermining and tension-free approximation of the skin edges in midline. For defects greater than 5-cm, a single-stage reconstruction can be performed using en bloc medial advancement of the latissimus dorsi and gluteus maximus bilaterally with the respective muscle flaps based on the thoracodorsal and superior gluteal vessels. Midline perforators are divided and submuscular dissection is carried laterally. The latissimus is separated from its attachments to the external oblique and serratus posterior while the gluteus maximus is detached from the iliac crest and sacrum. The muscles are advanced medially and sutured together in midline.