The use of Alloderm for a giant omphalocele with a ruptured sac and inadequate skin coverage

Giant omphaloceles often present with a loss of abdominal domain. An intact sac may permit simple daily dressings to promote epithelialization for a delayed operative closure; a ruptured sac presents challenges. There may be insufficient native tissue for adequate coverage; tissue expanders or grafts may be needed. We present a case of a ruptured omphalocele sac in which non-operative management was not possible – silo placement and reduction was unsuccessful due to a lack of abdominal domain. We used an acellular human dermal matrix (Alloderm, Life Cell, Branchburg, NJ), sutured to the patient's fascia to provide coverage of the omphalocele contents. There was insufficient skin to cover the majority of the graft. Tissue expanders had to be removed due to infection. With regular dressing changes, the tissue underneath the graft granulated and epithelialized and the graft lifted off. Skin grafting was not required. Alloderm's biologic properties render it less prone to infection than a synthetic graft; there was no evidence of graft infection in this patient. This ruptured omphalocele was managed with Alloderm coverage and minimal native skin.