Journal of Pediatric Surgery
Volume 41, Issue 11 , Pages 1836-1840, November 2006

Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy

  • Allen Gabriel

      Affiliations

    • Division of Plastic and Reconstructive Surgery, Loma Linda University School of Medicine Loma Linda, CA 92354, USA
  • ,
  • Gerald Gollin

      Affiliations

    • Division of Pediatric Surgery, Loma Linda University School of Medicine Loma Linda, CA 92354, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 909 558 4619; fax: +1 909 558 7978.

Abstract 

Introduction

In almost all cases of gastroschisis, fascial closure may be achieved primarily or after silo reduction. Rarely, fascial and skin closure are impossible. We report our experience with visceral coverage in complicated cases of gastroschisis with porcine small intestinal submucosa (SIS) augmented by negative pressure wound therapy (NPWT).

Methods

Over a 3-year period, 55 infants with gastroschisis were managed. In 3 of these cases, fascia and skin could not be approximated safely after complete reduction of abdominal viscera with a spring-loaded silo. Visceral coverage in each case was achieved with 0.42-mm-thickness Surgisis ES (Cook Surgical, Bloomington, Ind) that was sewn to the fascial edges. Negative pressure wound therapy was then initiated at 75 mm Hg over the exposed SIS using vacuum-assisted closure.

Results

In each case, granulation tissue developed quickly and was followed by complete epithelialization. Two patients subsequently developed umbilical hernias.

Conclusion

We have successfully used SIS augmented by NPWT in the management of 3 infants with complicated gastroschisis. In the rare situation in which fascial closure cannot be achieved, the combination of SIS and NPWT can provide a safe and effective means of abdominal wall closure.

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 Presented in part at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, Vancouver, British Columbia, Canada, May, 2005.

PII: S0022-3468(06)00457-X

doi:10.1016/j.jpedsurg.2006.06.050

Journal of Pediatric Surgery
Volume 41, Issue 11 , Pages 1836-1840, November 2006