title: Traction-compression-closure for exomphalos major.
abstract: OBJECTIVE
  We present our experience with traction-compression-closure (TCC) for exomphalos major (EM) to achieve a safe and embryologically correct midline supraumbilical aesthetic closure with preservation of the umbilicus.
  
  
  METHODS
  Nineteen neonates with EM were paralyzed and ventilated. The abdominal domain was increased by upward cord traction to assist liver-bowel reduction by gravity and sac ligation, followed by circumferential elastic body binder compression. The supraumbilical abdominal wall anomaly cicatrized spontaneously or was closed surgically as a midline scar, with preservation of the umbilicus.
  
  
  RESULTS
  Over 7 years (1998-2004), 19 patients with EM were treated by TCC, 18 of whom survived. The patients' median gestational age was 36 weeks (range, 24-40 weeks); their median birth weight was 2312 g (range, 890-3000 g). The median time to reduction was 4 days (range, 3-5 days), whereas that to full enteral feeds was 6 days (range, 4-6 days). Mechanical ventilation for 7 days (range, 6-8 days) was not associated with any morbidity, and the time to home discharge was 11 days (range, 8-12 days). Five patients did not require any surgery. There was no episode of sac rupture or infection.
  
  
  CONCLUSIONS
  Abdominal expansion by vertical cord traction followed by compression reduction (TCC) under muscle relaxation and ventilation is time well spent toward a safe and aesthetic midline abdominal wall closure without tension for EM.
authors.affiliation: Neonatal Surgical Unit, St Mary's Women and Children's Hospital, Manchester M13 9WL, UK. antonino.morabito@cmmc.nhs.uk <antonino.morabito@cmmc.nhs.uk>
authors.forename: Antonino
authors.initials: A
authors.lastname: Morabito
authors.forename: Anthony
authors.initials: A
authors.lastname: Owen
authors.forename: Adrian
authors.initials: A
authors.lastname: Bianchi
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D002675:Child, Preschool; D000071938:Fasciotomy; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D053828:Stockings, Compression; D014143:Traction; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*