Case report: staged surgical repair and negative pressure wound therapy in congenital omphalocel

Francesco Misticoni¹Valentina Chiavaroli^2*Chiara Cauzzo²Davide Fornaro Scarponcini²Maria Enrica Miscia³Mario Fusillo³Gabriele Lisi³Francesco Chiarelli¹Susanna Di Valerio²

• ¹Universita degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
• ²Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
• ³Presidio Ospedaliero di Pescara, Pescara, Italy

ABSTRACT Background: Omphalocele is a congenital abdominal wall defect consisting of abdominal contents protrusion at the base of the umbilical cord covered by a membranous sac composed of peritoneum and amnion. We report the case of a newborn with a giant omphalocele containing liver and bowel loops, undergone staged surgical closure followed by negative pressure wound therapy (NPWT) for the management of skin wound dehiscence. Case presentation: A male Caucasian infant was born at 35 weeks by elective caesarean section due to prenatal diagnosis of giant omphalocele. Clinical examination at birth confirmed a giant omphalocele with extensive liver and small bowel content. Cardio-respiratory and neurological examinations were unremarkable. The omphalocele was initially wrapped with hydrocolloid dressings. After bowel content reduction and epithelialization of its membrane, a 3-stage surgery was scheduled: firstly, a silo bag was fashioned (on day 22), then a complete liver reduction was obtained temporarily covered by a porcine dermal implant to close the gap in the wide muscle-fascial defect (on day 32), eventually the abdominal wall was fully closed without prosthetic material with component separation method (on day 68). NPWT was used in two stages for a total of 29 days. The first period, applied between the second and third interventions, began on day 37 and continued for 16 days. Due to partial dehiscence of the surgical wound, NPWT was restarted on day 75 and applied for 13 days, with increasing pressures (from -20 mmHg to -40 mmHg). Progressive improvement of the wound was obtained. After NPWT removal, an anti-microbial hydro-balanced dressing was placed. Conclusions: This case underlines the lack of a standardized therapeutic approach to complex abdominal wall defects. It also highlights the efficacy of NPWT in complicated surgical wounds in infancy, given the reduction in dressing frequency and related stress. Furthermore, NPWT guaranteed a relevant reduction in days needed for the surgical wound resolution.