Background: Tension free closure of large neural tube defects after excision poses a significant challenge to the operating surgeon. We are studying the role of one sided or double sided rhomboid flap tailored according to the shape and size of the large defect. Aim: A decision making for wound reconstruction in large neural tube defects: Role of one sided or double sided rhomboid flaps. Materials and Methods: This was a retrospective study where the case records of all the cases of neural tube defects performed over 1 year from January 2021 to January 2022 in the department of paediatric surgery at a tertiary care hospital were reviewed after approval from the institutional ethics committee. We reviewed a total number of 20 infants admitted to the pediatric surgery department at our center. Their age ranged between 10 days and 4 months. We classified the defect into mild, moderate and major; mild defect was defined as defect less than 3cms in diameter, the moderate one is between 3-5cms in diameter while the major defect more than 5cms. Data is collected regarding location and type of lesion, ruptured or intact MMC, associated bony deformity, dimension of the defect (vertical and transverse) when one or double sided rhomboid flap was done. Dressing is opened in post operative day 5 and different complications like wound infection, flap necrosis and wound dehiscence in post operative period were noted. Data were tabulated and analysed statistically by calculating the mean and range of the data for different measures. Result: A total of 20 patients were operated during this period. Mean age of surgery for NTDs excision and repair is 68 days (10 days – 4 months). Average dimension of the defect when one sided rhomboid flap used was 4.1cms x 3.9cms (average total surface area~16cm2) and average dimension of the defect when double sided rhomboid flap used was 6.3cms x 5.2cms (average total surface area~32.7cm2). Wound infection is the most common short term complication, total of 5 (25%) patients developed wound infection. Wound infection was mainly limited to redness and serous discharge but none of them had CSF leak. Three patients (15%) had flap necrosis while only single patient (5%) had wound dehiscence. Conclusion: We concluded that the rhomboid flap is safe and a versatile option with less morbidity and flap related complications. It is a good aesthetic solution that permits tension free closure in large neural tube defects