Porcine bladder extracellular matrix as a tissue regenerative strategy in a neonate with omphalocele and diaphragmatic agenesis

Abstract

Porcine bladder extracellular matrix (PEBM) is a biologic membrane that promotes tissue regeneration in neonates with complex surgical disease. PEBM promotes cellular infiltration and capillary ingrowth for site-specific tissue deposition, providing both form and function to the remodeled host tissue. We present a case demonstrating the feasibility of this matrix as a tissue regeneration strategy in a patient presenting with omphalocele and diaphragmatic agenesis. Patient is an ex 36 + 1 week infant with prenatally diagnosed omphalocele containing liver who underwent operative closure on day of life (DOL) 2. During the procedure the posterior half of the right diaphragm was found to be absent. This was subsequently replaced with a 5 × 5cm PEBM patch and 10 × 7cm PEBM sheet over the liver as an underlay to thin fascia with subsequent layered closure. Patient was extubated DOL 5, advanced to goal enteral feeds DOL 18, and discharged home DOL 23. An ultrasound of the chest obtained 6 months post-repair demonstrated normal diaphragmatic motion bilaterally. Patient had no evidence of an abdominal wall defect on exam at 1 year follow up. Chest radiograph at that time also showed normal diaphragmatic contour. Patient is currently 4 years old without clinical or radiographic evidence of recurrence of either defect.