create a silver-impregnated hydrofiber dressing for omphaloceles
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40 Steps
4 I Made It!
1
2

Gently clean the omphalocele with Sterile Saline Wipe.

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4

Overlapping the two pieces by about 1-2 cm.

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6

Extending the Aquacel Ag past the defect to allow for shrinkage of dressing while still remaining in contact with defect.

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8

Applying Aquacel Ag to cover the entire defect. Overlap edges allowing for shrinkage of dressing when it gels up with defect moisture.

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10

Apply Aquacel Ag 4 x 4 covering the defect and overlapping the edges of the base by 2 cm. The Aquacel Ag will shrink as it turns to gel and you want it to remain intact with the defect. Apply the Aquacel Ag dry. Use as many pieces as needed to cover defect. Giant omphaloceles have taken me up to (3) 4 x 4 Aquacel Ag dressings in the beginning. As the defect evolves, you use less and less until finally epithelialized/helaed.

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12

Take the Mepilex Border 4 x 12 and cut one upper edge, side edge and approximately 1 inch increments to left over border.

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The cuts in the mepilex border dressing allow the dressing to conform to the base and secure on the abdomen. The purpose of this dressing is to support the omphalocele in a somewhat upright position.

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16

Support the omphalocele, assuring the contents are stabilized.

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The Mepilex Border is a foam silicone dressing. The edge of the foam should meet the edge of the Aquacel Ag that lays underneath. The foam will help to absorb drainage that the omphalocele will give off as its normal process of evolving.

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The Aquacel Ag should not extend past the border as on the left base of the dressing. This will cause drainage to spill outside of the dressing. Notice the edge of the dressing as it overlaps to meet over the beginning of the Mepilex Border dressing.

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This is a Mepilex Border Sacrum 9x9. The border is cut into 1 inch increments. These cuts will allow the dressing to be applied and conformed to the defect.

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Remove the remaining right side backing of the sacrum dressing. Yes, this sacrum dressing was originally created to help adults with their sacral wounds! The backing on this dressing has 3 separate pieces to remove.

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The dressing is placed over the defect at the superior and inferior edges. If you look at the defect like the face of a clock, it would be applied first to 11, 12 and 1 o'clock. The inferior edges include 5, 6 and 7 o'clock. The dressing must come in contact with the Aquacel Ag.

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28

Tack the middle of the silicone dressing to the lateral edge of the defect.

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Start tacking the dressing at 2, 3 and 4 o'clock by looking at the defect like the face of a clock.

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The dressing is now applied to the right lateral side of defect. Fold out edges and tack them to the dressing.

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Fold the remaining corners of the dressing.

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Using the left over cut edges of Mepilex border, cut into 2-3 inch strips and reinforce any edges that need reinforcement.

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Reinforce dressing in needed areas.

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Please feel free to look up our two articles using this dressing approach: Almond, S., Reyna, R., Barganski, N., Emran, M. (2010). Nonoperative management of a giant omphalocele using a silver impregnated hydrofiber dressing: a case report, Journal of Pediatric Surgery, 45(7), 1546-1549. Oquiendo, M., Agrawal, V., Patel, H., Emran, M., Almond, S., (2015). Silver-impregnated hydrofiber dressing followed by delayed surgical closure for management of infants born with giant omphaloceles, Journal of Pediatric Surgery, 50(10), 1668-1672.