Abstract
We encountered a baby boy suffered from giant omphalocele with the liver and intestine contained within the sac. Soon after birth a silo using an Alexis® Wound Protector/Retractor S was sutured to the skin edges with excision of the amniotic sac. During the subsequent 11-day course, attempts at sac reduction resulted in minimal improvement. After removal of the silo, fascial closure was achieved using the GORE-TEX® Soft Tissue Patch. Skin closure was then completed. At 18 days old, due to skin necrosis around the suture line and infection under the patch, debridement of necrotic tissue and drainage under the patch using a J-VACTM drainage system were performed. To prevent infection, the patch was initially dressed with Aquacel® Ag. To avoid the occurrence of abdominal compartmental syndrome, we planned to undertake gradual closure of the fascia. The patch was removed partially and plicated at 56 days old. At 91 days old, the residual patch was removed and the abdominal wall was completely closed without stress, although patch infection had to be treated a week preoperatively. We suggest that control of patch infection without skin closure is a feasible approach, and that it is safe for the patient to have close fascia by gradual patch plication due to the lack of influence on hemodynamic and respiratory status.
