Abstract
Prolonged, tedious nursing care and the everpresent danger of meningeal rupture attend the expectant management of infants with myelomeningocele. Conversely, early operation minimizes the special care of these infants, decreases hospital stay, and may ease subsequent bracing and gait training. In the past, we have preferred early surgical treatment of myelomeningocele, but have been discouraged by difficulties encountered in obtaining skin and soft tissue closure in very large lesions. These are the infants whose defects are so large that neither primary midline closure nor the utilization of local rotational pedicle flaps is feasible. To facilitate repair of large myelomeningoceles we have, for the past two years, used large bilateral bipedicled advancement flaps and have achieved success in all seven patients treated by this method. Technique The method of repair is illustrated in the Figure ( B and D ). Bipedicled verticle flaps of skin and soft tissue are outlined bilaterally adjacent to
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