Spontaneous sutureless closure of the abdominal wall defect in gastroschisis using a commercial wound retractor system.

ABSTRACT

PURPOSE: We report our experience of using a commercial wound protector and retractor system to allow spontaneous sutureless closure of the abdominal wall defect in gastroschisis. METHODS: Following birth, eviscerated bowel is wrapped with polyethylene wrap, the umbilical cord is deliberately left long and kept moist, and the patient stabilized and transferred to the operating room. Then the Applied Alexis wound protector and retractor system (Applied Medical Resources Corp, USA) was used for reducing eviscerated bowel. Once all organs have been reduced, the wound protector and retractor system (WPAR) is removed and the abdominal wall defect covered with the umbilical cord without suturing. Tegaderm (3M Health Care, USA) is used as a film dressing and is removed once the umbilical cord becomes adhered. RESULTS: We have used this technique to treat seven neonates with gastroschisis between April 2006 and March 2009. In three, WPAR was used as a silo initially, and removed after 3-4 days, and in four, WPAR was used only until primary reduction was achieved and removed. The abdominal defect closed spontaneously in all cases with excellent cosmesis. There were no complications attributed to our technique. At the time of discharge, all patients had insignificant umbilical hernias which have all resolved spontaneously. CONCLUSION: The cosmetic appearance of the abdomen is improved using our technique compared with primary closure involving suturing and a conventional silo.