Our experience with the distally based latissimus dorsi flap in 12 patients (7 primary closures and 5 secondary procedures) indicates that it is an extremely reliable and useful flap in this setting. It provides coverage of the dural repair with viable soft tissues under a minimum of tension. The suture lines are distant from the dural closure, the donor defect closes primarily, and in the event of a complete failure, the contralateral latissimus dorsi remains available. In those cases of meningomyelocele where direct primary closure is not possible, we view this as the procedure of choice.