Allen Gabriel1, Gerald Gollin. 1. Division of Plastic and Reconstructive Surgery, Loma Linda University School of Medicine Loma Linda, CA 92354, USA.
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.
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.
Authors: Katherine B Santosa; Matt Keller; Margaret A Olsen; Alexandra M Keane; Erika D Sears; Alison K Snyder-Warwick Journal: J Surg Res Date: 2018-11-30 Impact factor: 2.192
Authors: Mona Baharestani; Ibrahim Amjad; Kim Bookout; Tatjana Fleck; Allen Gabriel; David Kaufman; Shannon Stone McCord; Donald C Moores; Oluyinka O Olutoye; Jorge D Salazar; David H Song; Steven Teich; Subhas Gupta Journal: Int Wound J Date: 2009-08 Impact factor: 3.315