Wound closure of the myelomeningocoele defect.

Our experience with 74 neonates with myelomeningocoele is reported. Management in the first phase of the study period consisted of primary closure in 37 patients by wide undermining and skin advancement, marked by a high wound-complication rate. Latissimus dorsi muscle closure, either "reverse" or advanced, was performed in a transitional phase in 5 patients, characterized by increased operative time and blood loss. In the last portion of the study period, 32 patients were managed by immediate dural closure and skin grafts either simultaneously or on a delayed basis at 48 to 72 hours with a low incidence of graft loss, CSF leak, or sepsis. Back ulceration and follow-up in either the primary closure or the skin-grafted group has been infrequent.