title: Management of a giant omphalocele with an external skin closure system.
abstract: 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.
authors.affiliation: Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.forename: Suad
authors.initials: S
authors.lastname: Gholoum
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.forename: Pramod
authors.initials: P
authors.lastname: Puligandla
mesh_terms: D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015625:Tissue Expansion Devices