Abstract
Myelomeningocele (MMC) is a congenital neural tube defect requiring early surgical intervention to prevent severe complications. Surgical closure can be challenging due to the possibility of complications such as partial flap loss, necrosis, wound dehiscence, and cerebrospinal fluid leakage. The Keystone Design Perforator Island Flap is a versatile option for covering large defects in complex cases such as MMC. This case presents the successful application of a Type III Keystone flap to repair an extensive thoracolumbar defect in a neonate with MMC, providing effective coverage and reducing complications, positioning itself as a trustworthy technique in pediatric reconstructive surgery.