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


METHODS
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.


CONCLUSIONS
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.
Baird
Robert
R
Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Gholoum
Suad
S
Laberge
Jean-Martin
JM
Puligandla
Pramod
P
D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015625:Tissue Expansion Devices