Management of a giant omphalocele with an external skin closure system.

Abstract:

BACKGROUND/PURPOSE:The management of neonates with giant omphalocele remains challenging and multiple strategies have been described. We present the case of a 34-week-old neonate with isolated giant omphalocele managed with an external surgical skin closure system as a component of a staged closure strategy. CASE PRESENTATION:An Inuit boy of 34 weeks gestation was born by urgent Caesarean delivery at an affiliated obstetrical hospital with a giant ruptured omphalocele and loss of abdominal domain. He was transferred to our institution and a silastic silo was fashioned and placed in the operating room. He returned to the operating room several times and was treated by placement of a combined Gore-Tex (WL Gore and Associates, Flagstaff, Ariz)/silastic inlay mesh. An eschar formed over this temporary closure, and we elected to place a dynamic skin closure device to continue gradual bedside reduction. The initial abdominal wall defect was 8.5 cm in transverse diameter and was reduced to 4.5 cm over 3 weeks. Complete closure was subsequently achieved without the need for skin grafting. DISCUSSION:The use of a dynamic reduction skin closure device has not been documented previously in the pediatric population or in the context of a congenital defect. We describe the use of an external surgical skin closure device in the context of the staged closure of a giant neonatal omphalocele and postulate that such a device may prove useful in the treatment of other congenital tissue defects.

journal_name

J Pediatr Surg

authors

Baird R,Gholoum S,Laberge JM,Puligandla P

doi

10.1016/j.jpedsurg.2010.05.004

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

E17-20

issue

7

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(10)00411-2

journal_volume

45

pub_type

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