Absorbable mesh and skin flaps or grafts in the management of ruptured giant omphalocele

Abstract

Purpose: The authors report the use of absorbable mesh closure with subsequent skin graft or skin flap coverage for giant ruptured omphalocele. Methods: Retrospective review of a single surgeon's experience was conducted from 1996 through 2001. Results: Four infants were identified presenting an average of 4 weeks prematurely. All patients had an initial attempt at silo reduction but had either infection or respiratory compromise. The silo was removed, and the defect was covered with polyglycan mesh followed by subsequent skin coverage. In 2 patients, final coverage was obtained using skin flaps, whereas in 2 patients, split-thickness skin grafts were required. All patients were noted to have a distinct narrow chest contour with evidence of pulmonary hypoplasia. Three patients had respiratory failure requiring tracheostomy and prolonged ventilation. Two children were decannulated after one and 2 years, respectively; the third child is booked for decannulation at age 12 months. Although these children have required multiple reoperations, they are all presently doing well with an average of 4 years of follow-up. Conclusions: Patients with giant omphalocele have associated pulmonary hypoplasia, which limits the ability to reduce the abdominal contents. Absorbable mesh coverage followed by split-thickness skin graft or skin flap coverage provides a viable biological coverage and minimizes ongoing pulmonary morbidity. The authors recommend a minimally aggressive attempt at sac reduction in the initial treatment of giant omphalocele and, if necessary, the use of absorbable mesh as a staged coverage with subsequent split-thickness skin grafting to minimize the pulmonary effects of the abdominal operation. J Pediatr Surg 38:725-728. © 2003 Elsevier Inc. All rights reserved.