Spontaneous sutureless closure of the abdominal wall defect in gastroschisis using a commercial wound retractor system.
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.
Ogasawara
Yuki
Y
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Okazaki
Tadaharu
T
Kato
Yoshifumi
Y
Lane
Geoffrey J
GJ
Yamataka
Atsuyuki
A
D034861:Abdominal Wall; D005260:Female; D020139:Gastroschisis / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012075:Remission, Spontaneous; D014945:Wound Healing
J Pediatr Surg. 2004 May;39(5):738-41
15137009
Ann Surg. 2003 Mar;237(3):301-15
12616113
J Pediatr Surg. 1997 Jan;32(1):66-8
9021572
Pediatr Surg Int. 2005 Nov;21(11):925-7
16193316
Gastroenterology. 2004 Jan;126(1):159-69
14699497
J Pediatr Surg. 2001 Nov;36(11):1672-4
11685699
J Pediatr Surg. 1998 Sep;33(9):1338-40
9766348
Pediatr Surg Int. 2001 Mar;17(2-3):242-4
11315303