Baird R, Gholoum S, Laberge JM, Puligandla P.
J Pediatr Surg. 2010 Jul;45(7):E17-20.
The management of neonates with giant omphalocele remains challenging and multiple strategies have been described. We present the case of a 34-week-old neonate with isolated giant omphalocele managed with an external surgical skin closure system as a component of a staged closure strategy.
An Inuit boy of 34 weeks gestation was born by urgent Caesarean delivery at an affiliated obstetrical hospital with a giant ruptured omphalocele and loss of abdominal domain. He was transferred to our institution and a silastic silo was fashioned and placed in the operating room. He returned to the operating room several times and was treated by placement of a combined Gore-Tex (WL Gore and Associates, Flagstaff, Ariz)/silastic inlay mesh. An eschar formed over this temporary closure, and we elected to place a dynamic skin closure device to continue gradual bedside reduction. The initial abdominal wall defect was 8.5 cm in transverse diameter and was reduced to 4.5 cm over 3 weeks. Complete closure was subsequently achieved without the need for skin grafting.
The use of a dynamic reduction skin closure device has not been documented previously in the pediatric population or in the context of a congenital defect. We describe the use of an external surgical skin closure device in the context of the staged closure of a giant neonatal omphalocele and postulate that such a device may prove useful in the treatment of other congenital tissue defects.
Price J, Rubens F, Bell M.
Ann Thorac Surg. 2007 Mar;83(3):1162-5.
Management of the sternal wound after extensive debridement continues to be a resource-intensive problem in cardiac surgery. There are a number of techniques available to achieve definitive closure of these wounds, all of which have limited effectiveness or are associated with serious complications. This article describes the use of a novel elastic system that approximates these wounds gradually, achieving dynamic wound closure. The purpose of this study is to evaluate the efficacy of this system.
We report our initial series of 3 patients who underwent dynamic wound closure using a novel elastomer system after debridement for sternal wound infection.
All patients achieved satisfactory healing with a mean duration of 29 days of treatment without additional procedures.
Dynamic wound closure is an effective and feasible method of dealing with the open sternotomy wound after debridement.