Vita Boyar, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
J Wound Ostomy Continence Nurs. 2020 Nov/Dec;47(6):622-626. doi: 10.1097/WON.0000000000000701.
A giant omphalocele is a rare congenital abdominal wall defect that measures more than 6 to 8 cm in any dimension. The child's abdominal visceral contents as well as the liver which are both covered by the amniotic sac protrude outside the abdomen through the umbilicus. Consequently, closing this defect is extremely challenging due to the risk for wound dehiscence.
Baby C, a 1-year-old male infant, developed a dehisced abdominal wound after secondary repair of a giant omphalocele. Escharification of the amniotic sac was achieved with silver products, followed by intra-abdominal tissue expansion and skin closure. A conservative approach was undertaken with the use of cryopreserved human umbilical cord and amniotic membrane allograft in conjunction with portable negative pressure therapy.
To the best of our knowledge, this is the first case study to evaluate the effect of cryopreserved human umbilical cord and amniotic membrane allograft in a dehisced neonatal abdominal wound due to a giant omphalocele or, in fact, neonatal wounds in general. Our experience with this case suggests that cryopreserved human umbilical cord and amniotic membrane allograft may create a superior healing trajectory and regeneration, avoidance of surgical intervention, and an early hospital discharge. Wound-supporting properties of amniotic allograft, in addition to lack of immunologic reactivity, offer an attractive option for a variety of pediatric and neonatal wounds.
巨大脐膨出是一种罕见的先天性腹壁缺陷，其任何维度均超过 6 至 8 厘米。婴儿的腹部内脏器官以及被羊膜覆盖的肝脏均通过脐部突出于腹部外。因此，由于存在伤口裂开的风险，闭合该缺陷极具挑战性。
婴儿 C 是一名 1 岁男性，在接受巨大脐膨出的二次修复后出现腹部伤口裂开。通过银制品对羊膜进行焦痂化处理，随后进行腹腔内组织扩张和皮肤闭合。采用冷冻保存的人脐带和羊膜同种异体移植物联合便携式负压治疗的方法采取了保守治疗。
据我们所知，这是首例评估冷冻保存的人脐带和羊膜同种异体移植物在因巨大脐膨出或新生儿一般伤口裂开的新生儿腹部伤口中的效果的研究。我们对该病例的经验表明，冷冻保存的人脐带和羊膜同种异体移植物可能会产生更优的愈合轨迹和再生效果，避免手术干预，并可早日出院。羊膜同种异体移植物的伤口支持特性，加上其无免疫反应性，为多种儿科和新生儿伤口提供了极具吸引力的选择。
