Med J Malaysia. 2025 Dec;80(Suppl 6):69-80.
ABSTRACT
INTRODUCTION: In cases of gastroschisis and ruptured omphalocele where primary closure is not feasible, physicians must employ alternative strategies to gradually reduce the herniated contents and promote epithelialization, either through non-surgical methods or with surgical intervention. Negative pressure wound therapy (NPWT) is a device specifically designed to promote wound healing by controlling sub atmospheric pressure. Despite the benefits of NPWT, its use in paediatric patients, particularly congenital abdominal wall defect, remains unclear. This study aimed to assess the benefits of NPWT as part of the treatment strategy for gastroschisis and ruptured omphalocele.
MATERIALS AND METHODS: A literature search was conducted through electronic databases including Pubmed, ScienceDirect and JSTOR from inception through January 2025. The outcomes identified included NPWT application details (pressure, timing, duration), outcomes related to length of stay, initial feeding, complications, wound progression, and follow-up results. Quality assessment was not conducted as the review aimed to provide a broad overview of the topic.
RESULTS: Sixteen studies were included in the final analysis. Subjects consisted of 41 patients (32 gastroschisis, and 9 ruptured omphalocele), with a mean gestational age of 36.9 weeks and a mean birth weight of 2,216 g. The most common herniated contents were small bowel and liver, with an average defect size of 6 cm. The initial NPWT pressure ranged from -25 mmHg to -100 mmHg, with -40 mmHg being the most common starting pressure. At 10-12 months followup, most subjects demonstrated no fascial defects and intact epithelialized skin. NPWT was found to be an effective alternative, particularly as part of immediate primary closure, facilitating wound healing during staged closure, or managing infection. Although most evidence came from case reports or series, and there is a lack of standardized protocols for NPWT, its benefits over conventional care were evident.
CONCLUSION: NPWT shows its benefit in adjunct to delayed closure, primary suture less closure, and in the management of gastroschisis and ruptured omphalocele. Future research should further investigate the optimal use of NPWT in a larger larger prospective or randomized controlled trials to refine protocols and better understand its long-term benefits and risks.
PMID:41451725
