The birth of an infant with myelomeningocele provides a devastating experience for parents, a management dilemma for medical personnel, and an economic liability of immense proportions associated with the multiple disciplinary management program throughout the patient's life. Although undue delay in the onset of therapy is to be avoided, time can be taken for thorough assessment and appropriate discussion with the family without compromising the outcome. Once decisions are made to proceed with repair, early cover of the myelomeningocele defect is necessary to prevent progressive loss of neural tissue through exposure, desiccation, and sepsis. Many techniques of repair have been advocated. In principle, the ideal should be applicable to all sizes of defect, should be able to be executed in the neonatal age group with minimal morbidity, and should provide long-term, stable soft tissue cover without significant secondary scarring. A technique adhering to these principles is described and supported by results in a personal series of 84 patients during a 12-year period.