# Case Report: Staged surgical repair and negative pressure wound therapy in congenital omphalocele

## TL;DR

A newborn with a large omphalocele underwent staged surgery and negative pressure wound therapy, which helped manage wound dehiscence and improve recovery.

## Contribution

This case report demonstrates the effectiveness of staged surgical repair and NPWT in managing complex omphalocele wounds in infants.

## Key findings

- Staged surgical closure combined with NPWT successfully managed a giant omphalocele in a newborn.
- NPWT reduced dressing frequency and wound healing time in a complex abdominal wall defect.
- The use of NPWT was effective in treating wound dehiscence following abdominal wall repair.

## Abstract

Omphalocele is a congenital abdominal wall defect that causes the protrusion of the abdominal organs at the base of the umbilical cord, which is covered by a membranous sac composed of the peritoneum and amnion. We report the case of a newborn with a giant omphalocele containing the liver and bowel loops who underwent staged surgical closure followed by negative pressure wound therapy (NPWT) for the management of skin wound dehiscence.

A male Caucasian infant was born at 35 weeks by elective cesarean section due to a prenatal diagnosis of a giant omphalocele. The clinical examination at birth confirmed a giant omphalocele with extensive liver and small bowel content. Cardio-respiratory and neurological examinations were unremarkable. The omphalocele was initially wrapped with hydrocolloid dressings. After bowel content reduction and epithelialization of the membrane, a three-stage surgery was scheduled as follows: first, a silo bag was fashioned (on day 22); then, after complete liver reduction, the wide muscle-fascial defect was temporarily covered by a porcine dermal implant to close the gap (on day 32); finally, the abdominal wall was fully closed without prosthetic material using the component separation method (on day 68). NPWT was performed in two stages for a total of 29 days. The first period, applied between the second and third interventions, began on day 37 and continued for 16 days. Due to partial dehiscence of the surgical wound, NPWT was restarted on day 75 for 13 days, with increasing pressure (from −20 to −40 mmHg). Progressive improvement of the wound was obtained. After NPWT removal, an antimicrobial hydro-balanced dressing was placed on the wound.

This case underlines the lack of a standardized therapeutic approach for complex abdominal wall defects. It also highlights the efficacy of NPWT in complicated surgical wounds in infancy, given the reduction in dressing frequency and related stress. Furthermore, NPWT guarantees a significant reduction in the number of days required for the resolution of the surgical wound.