Visceral coverage with absorbable mesh followed by split-thickness skin graft in the treatment of ruptured giant omphalocele

Abstract

We report a case of ruptured giant omphalocele in whom herniated organs were successfully covered by an absorbable mesh and a subsequent skin graft. A 2,200 g male baby was born at 35 weeks of gestation. An abdominal wall abnormality was detected by prenatal ultrasound at 21 weeks of gestation. At birth, the entire liver, stomach, and small and large bowel had herniated from the defect of the abdominal wall. The thorax and abdomen were highly underdeveloped, and attempts to reduce the organs into the abdomen were unsuccessful due to the extremely small abdominal cavity and associated pulmonary hypoplasia. To protect the herniated organs and prevent abdominal infections, the organs were covered by a polyglycan mesh and subsequently a meshed split-thickness skin graft. Ten weeks later, it was confirmed that the organs were completely covered by epithelialized tissue. However, the patient suffered from frequent respiratory infections and finally died of respiratory insufficiency. Based on the experience of the patient, we conclude that coverage of the herniated organs with an absorbable mesh and a skin graft is a recommendable treatment in ruptured giant omphalocele.

Management of a giant omphalocele with an external skin closure system

“…In the absence of an intact sac, several options exist. Absorbable mesh has been used to cover the defect followed by either mobilizing skin flaps or using skin grafts to achieve complete coverage [3,19]. Intestinal fistula remains a risk with this technique.…”

Use of hyaluronic acid-derived dermal substitute for skin reconstruction in giant omphalocele

“…Yamagishi et al [14] reported the management of one case of ruptured GO that was first treated with application of a silo bag for 3 weeks followed by application of vicryl mesh for 2 weeks, and finally meshed split thickness skin graft was applied. After 2 weeks, the skin was fully reconstructed.…”

“…The child died at the age of 8 months because of respiratory insufficiency. Yamagishi et al [14] considered their steps of management as a standard protocol for the treatment of GO and gastroschisis.…”

“…The prognosis of giant omphalocele (GO) depends on the presence of other associated major structural and/or chromosomal abnormalities, which are now detected antenatally [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors

“…The described surgical techniques were categorized according to the literature as primary closure (defined as primary closure of the defect in one operation, with or without extracorporal material, shortly after birth) [1][2][3][4][5][6][7][8][9][10], staged closure (closure of the abdominal wall defect in more than 1 operative procedure) , and delayed closure of the abdominal wall after epithelialization of the OC sac [36][37][38][39][40][41][42][43][44][45][46][47][48].…”