Combined negative pressure wound therapy with new wound dressings to repair a ruptured giant omphalocele in a neonate: a case report and literature review.

Abstract

Background: Current treatment of giant omphalocele in newborns is not standardized. The main treatments include one-time repair and staged surgery using synthetic and biologic mesh, or silos. However, surgery can lead to various postoperative complications. Recently, negative pressure wound therapy (NPWT) has been recommended as an effective method for giant omphalocele. We adopted NPWT and some new wound dressings for a case of ruptured giant omphalocele. Vaseline gauze (VG), followed by silver-containing sodium carboxymethylcellulose dressing(CMC-Ag)was used to control infection. NPWT was mainly performed to promote granulation and accelerated healing. Recombinant human basic fibroblast growth factor (Rh-bFGF) was used to heal the wound. No studies have conducted NPWT and new wound dressings healing the wound of ruptured giant omphalocele. Therefore, we present our management experience in this case.

Case presentation: The patient was a baby boy aged 2 days, weighing 2930 g. He was diagnosed with a giant omphalocele with a partial intestine exposed. Two hours after admission, the baby underwent a silo placement. The herniation of the bowel was gradually reduced into the abdominal cavity. At the age of 13 days, the stitches at the bottom of the silo fell off, and the liver was exposed with the defect size about 8 cm x 10 cm. The hole failed to be repaired by surgery. We used VG and CMC-Ag patched on the defect hole. After creating a moist and fresh environment, NPWT was then applied mainly to extract excess fluid and promote granulation. CMC-Ag was performed for 19 days when the wound showed no exudate or infection. NPWT was stopped at the age of 47 days when the granulation tissue was fully formed with the defect size reduced to 4.5 cm x 3.5 cm. After halting the NPWT, the wound was managed with Rh-bFGF and VG. At the age of 2 months, the wound was reduced to 1 cm x 1 cm with satisfactory epithelialization.

Conclusions: NPWT is a safe and effective alternative therapy for the repair of giant omphalocele. CMC-Ag can help control wound infection and manage exudate and Rh-bFGF promotes wound healing. NPWT combined with new wound dressings can effectively manage ruptured giant omphalocele.

Clinical trial number: Not applicable.