title: Spontaneous sutureless closure of the abdominal wall defect in gastroschisis using a commercial wound retractor system.
abstract: OBJECTIVE
  We report our experience of using a commercial wound protector and retractor system to allow spontaneous sutureless closure of the abdominal wall defect in gastroschisis.
  
  
  METHODS
  Following birth, eviscerated bowel is wrapped with polyethylene wrap, the umbilical cord is deliberately left long and kept moist, and the patient stabilized and transferred to the operating room. Then the Applied Alexis wound protector and retractor system (Applied Medical Resources Corp, USA) was used for reducing eviscerated bowel. Once all organs have been reduced, the wound protector and retractor system (WPAR) is removed and the abdominal wall defect covered with the umbilical cord without suturing. Tegaderm (3M Health Care, USA) is used as a film dressing and is removed once the umbilical cord becomes adhered.
  
  
  RESULTS
  We have used this technique to treat seven neonates with gastroschisis between April 2006 and March 2009. In three, WPAR was used as a silo initially, and removed after 3-4 days, and in four, WPAR was used only until primary reduction was achieved and removed. The abdominal defect closed spontaneously in all cases with excellent cosmesis. There were no complications attributed to our technique. At the time of discharge, all patients had insignificant umbilical hernias which have all resolved spontaneously.
  
  
  CONCLUSIONS
  The cosmetic appearance of the abdomen is improved using our technique compared with primary closure involving suturing and a conventional silo.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kato
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D034861:Abdominal Wall; D005260:Female; D020139:Gastroschisis / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012075:Remission, Spontaneous; D014945:Wound Healing
references.citation: J Pediatr Surg. 2004 May;39(5):738-41
references.pmid: 15137009
references.citation: Ann Surg. 2003 Mar;237(3):301-15
references.pmid: 12616113
references.citation: J Pediatr Surg. 1997 Jan;32(1):66-8
references.pmid: 9021572
references.citation: Pediatr Surg Int. 2005 Nov;21(11):925-7
references.pmid: 16193316
references.citation: Gastroenterology. 2004 Jan;126(1):159-69
references.pmid: 14699497
references.citation: J Pediatr Surg. 2001 Nov;36(11):1672-4
references.pmid: 11685699
references.citation: J Pediatr Surg. 1998 Sep;33(9):1338-40
references.pmid: 9766348
references.citation: Pediatr Surg Int. 2001 Mar;17(2-3):242-4
references.pmid: 11315303