The use of human acellular dermis in the operative management of giant omphalocele.
OBJECTIVE
The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (AlloDerm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele.


METHODS
Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome.


RESULTS
Three neonates underwent abdominal wall closure with AlloDerm (gestational ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomalies; 1 required cardiac surgery and 1 was ventilator-dependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication.


CONCLUSIONS
AlloDerm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. AlloDerm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.
Kapfer
Stephanie A
SA
Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110,USA.
Keshen
Tamir H
TH
D003094:Collagen / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest; D006330:Heart Defects, Congenital; D006554:Hernia, Umbilical / Q000150:complications / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D017768:Skin, Artificial; D016896:Treatment Outcome; D014945:Wound Healing
C440568:Alloderm; D003094:Collagen