1. Staged abdominal closure with intramuscular tissue expanders and modified components separation technique of a giant incisional hernia after repair of a ruptured omphalocele 
Yukihiro Tatekawa, Akito Komuro, Ai Okamura 
Journal of Pediatric Surgery Case Reports 
Volume 10, Pages (July 2016)
DOI: /j.epsc
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2. Fig. 1
Treatment of ruptured omphalocele. a) In ruptured omplalocele, intestines and stomach are outside of the body. b) Preoperative physical examination shows the skin defect to measure 100 mm × 100 mm. c) Abdominal computed tomography (CT) reveals the muscle defect to be 100 mm × 65 mm. d) The placement of kidney-shaped tissue expanders between the internal oblique and transverses abdominis. e) Bilaterally, tissue expanders are placed and a total of 130 ml saline solution is injected. f) After insertion of tissue expanders, CT reveals the layers of the abdominal wall expanded by approximately 2 cm bilaterally.
Journal of Pediatric Surgery Case Reports  , 10-13DOI: ( /j.epsc )
Copyright © 2016 The Authors Terms and Conditions

3. Fig. 2
Modified components separation technique. a) After dissection of the skin and subcutaneous fat from the anterior rectus sheath and the aponeurosis of the external oblique muscle, the aponeurosis of the external oblique muscle is transected longitudinally at the lateral border of the rectus abdominis muscle and the external oblique muscle is separated from the internal oblique muscle (arrow indicates separated apponeurosis of the external oblique muscle). b, c) The posterior sheath is incised posteriorly and the rectus abdominis muscle is easily separated from the posterior rectus sheath (b; right side, c; left side). d) Skin flaps are resected as much as possible, with part left behind secondary to intestinal adhesions. e) A suction drain is placed under the muscle layer and the abdominal wall is sutured with an interrupted suture of an absorbable suture material, taking big bites of fascia by inverting the skin flaps. f) The abdominal wall is successfully closed in the midline without tension. g) On closure of the skin in the midline, a relaxation incision is performed bilaterally, finally covering the midline with artificial dermis. h) The wound infection and dehiscence improve and heal.
Journal of Pediatric Surgery Case Reports  , 10-13DOI: ( /j.epsc )
Copyright © 2016 The Authors Terms and Conditions