Background Data: Failure of closure of the caudal end of the neural tube is believed to be the embryological cause of spina bifida. Surgical repair is the ultimate solution and consists of multiple steps. Skin closure is the final and main step and is essential for a successful repair. We focused on different types of skin closure in the current study. Purpose: To set predictive factors for selecting different types of skin closure in the closure of spina bifida aperta. Study Design: A retrospective case study. Patients and Methods: Between April 2016 and April 2017, 30 patients (16 males and 14 females) who underwent surgical intervention for spina bifida aperta were reported. Twenty-four patients (80%) had myelomeningocele, 3 patients (10%) meningocele, and 3 patients (10%) myeloschisis. The types of skin closure designs were recorded and evaluated. Moreover, the factors that can affect designing the skin closure presented in this study were reported and evaluated retrospectively. Results: In this series, 60% (N = 18) of the patients underwent primary closure, 13.3% (N = 4) closure by using double transpositional skin flaps, and 26.6% (N = 8) skin closure using double rotational skin flaps. Conclusion: The data of this study may suggest that, in patients with spina bifida aperta, selection of the primary direct skin closure and skin flap closure is a significant predictor of the final outcome. The presence of a pedicle and the size of the mass in relation to the back were significant outcome factors, while the shape of the defect was not a significant outcome factor. (2020ESJ207)