Giant Omphalocele Dressing Change Demonstration

Hello, I'm Doctor Steven Fenton, a pediatric surgeon here at Primary Children's Hospital and the director of the Grant Scott Bonham Fetal Center. And today, I'm gonna show you how to care for a giant omphalocele wound. Let's go over the supplies that you're going to need to perform the wound care on a giant omphalocele. First, scissors in order to cut off the old dressing easily. Next, some 4x4s, and they don't need to be sterile, and this is primarily to help wipe off the old cream and to help debride the omphalocele just by gently scrubbing it. Then you're gonna want to put 1% silver sulfadiazine on the omphalocele. And a lot of times people like to use a tongue depressor in order to get it out. Um, I sometimes just use my hands either way. After you've done that, it's important to put non-adherent strips around the omphalocele so that the next dressing doesn't stick to it. We use Curity here. Some institutions have something called adaptic, which is similar. Then you can see 4 inch. Um, Cerlex is used to wrap the omphalocele. Once that's done, we use some Coban in order to just tighten it up and secure it. Sometimes a piece of tape is needed to help uh keep both the Kerlex and the Coban in place. The first part is many people think that this needs to be a sterile procedure, but it's not, because what will actually happen is the same bacteria that colonizes the skin will begin to colonize the omphalocele. So you want it to be clean, but it doesn't need to be sterile. We need to expose it first, and you can see that there's already a dressing here. And as kids will be somewhat resistant, but it shouldn't be, it shouldn't be painful, so they don't necessarily need any pain medications. And sometimes the easiest thing to do is to just carefully use some scissors. To help cut the portion off that goes around the back. You obviously want to be careful of limbs. And any other structures like. Leads, temperature monitors, etc. So you can see I just cut the part that went around the back on the side. And that'll help me kind of unwrap it. And this Coban just adds an extra layer of kind of reinforcement. And then there's Cerlex underneath. So, you need to get the Coban off. And the Kerlix. Once you've cut it, it should easily unwrap. And then after the Cerlex, there's gonna be non-adherent gauze immediately on it. And you can see I'm taking that off here. And it'll be OK if He touches it. And I'm just going to throw this away. And just change my gloves because they've got, well, actually, before I change my gloves. Take some gauze and just kind of wipe it off. And it's just to help wipe any debris that might be on there and to get some of the old Silvadene cream off. Now, If we look at this, This is what we would call escar, and it's just like a big scab, and you can start seeing these little pink areas, and the pink area really is new tissue that's being formed. So this would be granulation tissue and there's islands of granulation tissue, and then the skin will actually begin to epithelialize from the base up and so it's going to change shape, it's going to change form, it's going to change the way it looks over the course of it healing. But eventually what we want it to be is a really big hernia that's just covered with skin. So now that I've wiped it off, I'm going to change my gloves. Again, they're not sterile gloves. And the first thing we're gonna do. I put Silvadene cream. It's 1% on any area that has. Escar or that has that scab and new and new um tissue. So some people like to use a tongue depressor to get it out of the bottle. I just like oftentimes use my fingers. And it's a lot like. Frosting a cupcake. You just want to wipe it all over. And the reason we do this is, It's an antibiotic. And it's going to make sure that good bacteria colonizes it and not bad bacteria. And most of the time, over by where the umbilical cord was, You'll get some gunky tissue, so you wanna make sure that you really get that covered. Now, can you do me a favor and open the non-adherent gauze? So you need an assistant. I have 2, you probably want 2. And now where wherever that Silvadene cream is, we want to take this gauze. And put it. Everywhere and there's usually 3 pieces that come with this, so I usually take 1 around one side. One around the other side, and then we take one. Over the top and this really Is just to prevent. Curlex from sticking so it helps keep that cream on. And it prevents the curlex from sticking to the omphalocele. And you can see that he's tolerating this all very well. So here's our Kerlex now. This is how I do it. You guys can get your own method, but I like to put a little bit on top. To cover the top And then once I get a little layer on top, what we wanna do is go around, around it. And first I go around the whole phallocele, starting with the base, again, making sure there's no limbs included or. EKG leads. Now, now that I have it surrounding the omphalocele, we want to go around the back to give it some support. So these guys are going to help me and lift them up. So now you can see I go around the back one way. Again, making sure that I don't include any of the leads like I was doing there. And then I go around the base. And back around the back and you don't have to do it too tight. You just want to make sure that you have support and that it's well covered. Now, I'm going to go around one more time. And then sometimes what I like to do is go around. The top. Up above here. OK, you guys can put them down for a minute. And let's get scissors. I'm just going to cut, Cut this excess curlex here. Out, And now the next step is Coban. Now you can put Coban on really tightly and you kind of want to pull it, but you don't want to crank it onto the onto the omphala seal. So again, I kind of put a little layer on the top. Just to make it look pretty. And then we'll start going around the sides. And There we go, buddy. And you can see I'm, uh, we want to really kind of maintain the shape and we want it to be close to a Coke can. Now, this is bigger than a Coke can because he's. Young and small. Now, now that I've done that, let's go around the back again. And, and it's just to offer some support and kind of keep it in an upright position. You can see I went around the back, I'm going around the um the base. I'm coming back around the back. And this, I've gone around the back twice, is probably gonna be just plenty, and I, I'm not really doing it too tight around the back cause you don't want to cause a wound in the back, and you can set them down. And now I'm just gonna come up top. And we'll cut that little extra coban. And most of the time, you can just kind of stick it down to it. If it doesn't, we can just get a piece of tape. Hold that right there for me, Carrie. We can just put a piece of tape on it to hold it. Thank you. Get a little piece of tape just to hold it in place. So that is how you perform daily wound care of a giant omphalocele and in reality we want the parents to learn how to do this and to feel comfortable doing it on their own and you can even bathe the child before you do the dressing change so if they want to do it every day after a bath. They take the dressing off, bathe him just like they would, and they can bathe this area just as if as if it's a normal part of his body, and then after they dry it, they can go ahead and perform the dressing care. Thank you.