We have sequenced the breakpoints of deleted mtDNA in muscle from four children with mitochondrial myopathy and multisystem mitochondrial disorders. The deletions were 4884, 6067, 7663 and 7150 base pairs (bp) in size and affected several protein and transfer RNA genes. The sequences needed for transcription and replication of mtDNA were not affected in any case. The deletions were flanked by direct short repeats in all cases. Multiple repeats were found in case 1 and 4. Imperfect repeats were found in case 3 and 4 and this made it possible to distinguish the repeats 5' and 3' to the deletion. In both cases the 3' repeat was retained. The deletion of 7663 bp in case 3 has been reported in two other cases and may represent a second hotspot for mtDNA deletions in addition to the common deletion of 4977 bp found in one third of cases. A comparison of the breakpoint sequence of case 3 with the two other reported cases revealed that when a deletion is formed between the same repeats in different patients either the 5' or 3' repeat can be retained. This study shows that both single and multiple repeats can be associated with single mtDNA deletions and that both 5' and 3' repeated sequences can be retained. These findings are consistent with the slip-replication model for the generation of mtDNA deletions.