PMC7527617_01
Giant omphalocele (GO) findings immediately after birth. A female neonate was born at 38 weeks estimated gestational age with a birthweight of 3047 g. She had a GO with a fascial defect measuring 6 x 6 cm, and no abnormalities were found other than the GO.
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She had an intact GO with a fascial defect measuring 0.06 x 0.06 m (Fig. 1).
Findings fixing the small size wound retractor (SWR) to the abdominal wall. Since the hepatic veins firmly adhered to the cranial fascia of the abdominal wall defect and the SWR could not be inserted the fascial defect, the SWR was fixed to the abdominal wall.
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Hence, the SWR was fixed to the abdominal wall (Fig. 2).
Findings fixing a biomaterial soft tissue patch to the fascia around the abdominal wall defect. A biomaterial soft tissue patch was sutured to the fascia around the abdominal wall defect to form a new silo after removing the small size wound retractor and amniotic membrane.
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Inc., Newark, NJ, USA) was sutured to each fascia to form a new silo after removing the SWR and sac (Fig. 3). In addition, a sterile dressing of silver (AQUACEL Ag Extra TM, ConvaTec, England & Wales) was attached to prevent infection in the silo.
a-d: Findings from the silo infection control to introducing the negative pressure wound therapy (NPWT) device to the jejunal perforation and taking countermeasures.
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By day 65, the infection was under control, and a fibrous capsule had formed on the surface of the viscera and had stabilized them (Fig. 4a). The system was set at -25 mmHg (Fig. 4b). On day 71, it was discovered that a part of the epithelializing capsule had ruptured, and the jejunum had perforated (Fig. 4c). Sweden) (Fig. 4d), re-epithelialization of the capsule progressed smoothly (Fig. 5a).
a-d: Findings from incomplete epithelialization to repairing the perforated jejunum and completing the epithelialization using a collagen-based artificial dermis.
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By day 178, the epithelial layer had advanced to the periphery of the natural intestinal fistula (Fig. 5b), and hence, an incision was made along the epithelialization area, and the intestinal fistula was drawn out and repaired. Therefore, a collagen-based artificial dermis (Terudermis , Olympus Terumo Biomaterials Corp, Tokyo, Japan) was cut according to the size of the incision area and fixed by suturing (Fig. 5c). By day 247, epithelialization of the abdominal wall was almost complete (Fig. 5d), and on day 328, the patient was discharged from our hospital.