Abstract / Summary
Fascial dehiscence is a severe complication following neonatal laparotomies. In extreme circumstances precipitated by aggressive fluid resuscitation, primary fascial and skin closure may not be possible. We present the case of a neonate with a large abdominal wall defect treated with an acellular dermal matrix and negative pressure wound therapy. A 2-week-old male neonate born at 28 weeks of gestation, weighing 720 g, was initially diagnosed with medical necrotizing enterocolitis and treated with bowel rest and broad-spectrum intravenous antibiotics. During the second week of therapy, he developed abdominal wall erythema and peritonitis, prompting urgent laparotomy for resection of necrotic bowel. Surgery was associated with significant blood loss, hemodynamic instability, and high-volume fluid resuscitation. Fascial dehiscence occurred on postoperative day 5 and primary fascial closure was no longer possible due to severe fluid overload coupled with ongoing hemodynamic fragility. A 2.4 ± 0.4 mm nominal thickness sheet of acellular human dermal matrix was sutured to the patient's fascia circumferentially to reconstruct the 9 × 3.5 cm defect. Given the lack of adequate skin coverage, a negative pressure wound dressing was placed over the exposed dermal matrix. With regular dressing changes, revascularization and full epithelialization developed over the graft over the course of 9 months. This case was complicated with one episode of sepsis and two stitch-related skin granulomas treated with wound care. Further reconstruction or skin grafting has not been required in 4 years of follow-up. Utilization of an acellular human dermal matrix graft followed by negative pressure therapy offers potential for managing combined abdominal wall and skin domain defects in a neonate.