Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellul...Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (Allo-Derm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele. Methods: Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome. Results: Three neonates underwent abdominal wall closure with Allo-Derm (gestati- onal ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomal- ies; 1 required cardiac surgery and 1 was ventilatordependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication. Conclusions: Allo-Derm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. Allo-Derm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.展开更多
文摘Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (Allo-Derm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele. Methods: Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome. Results: Three neonates underwent abdominal wall closure with Allo-Derm (gestati- onal ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomal- ies; 1 required cardiac surgery and 1 was ventilatordependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication. Conclusions: Allo-Derm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. Allo-Derm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.
