ORIGINAL ARTICLE Cornelia van Tuil Æ Amulya K. Saxena Gu¨nter H. Willital Experience with management of anterior abdominal wall defects using bovine pericard Received: 6 June 2005 / Accepted: 23 June 2005 / Published online: 18 February 2006 Ó Springer-Verlag 2006 Abstract During 5 years from 1999 until 2003, our experience with 29 (100%) neonates managed for ante- rior abdominal wall defects is presented. Twenty-one (72%) neonates presented with gastroschisis and 8 (28%) neonates with giant omphaloceles. The male: female ratio was almost equal in gastroschisis (1:1) while a male predominance was observed in omphaloceles (6:1). A primary closure of the defect was possible in 5 (17%) cases and a single patch along with skin closure was achieved in a further 9 (31%) cases. In 15 (52%) neonates the defect was large and two patches were employed to sufficiently cover the defect. All patients (97%), except one (mortality due to extreme prematu- rity), were managed successfully. Depending upon the size of the defect and the metabolic condition of the neonate, the defect closure was completed after a mean of 85.7 days. Special protocols were created to manage the bovine pericard patches, which behaved differently to lyophilized dura patches previously used at our cen- ter. Integration of the patches was successful in 28 (97%) neonates; however, one neonate with gastroschisis pre- sented significant challenges in the management. Bovine pericard patches are optimal biomaterials for the closure of anterior abdominal wall defects in gastroschisis and omphaloceles. Keywords Bovine pericard Æ Gastroschisis Æ Omphalocele Æ Biomaterials Introduction Biomaterials, such as dura mater, have been employed in human surgical procedures since the late 1950s, since it fulfills the considerations for a substitute material which includes antigenicity, toxicity, strength, elasticity, sutu- rability, availability and expense [1]. Preservation tech- niques such as freeze-drying (lyophilization) or solvent- drying led to the widespread use of homologous cadaveric dura [2–4]. For many years these cadaveric implants seemed very well suited for the use as dural grafts, presenting almost no complications. Our large experience with solvent-dried dura in the management of anterior abdominal wall defects and its successful out- come was reported [5, 6]. However, after the outbreak of Creutzfeld-Jacobs disease in the United Kingdom in the late 1990s and owing to the fear of probable transmis- sion of the disease using dura patches, these patches were removed from the market and were presumed unfit for human usage [7–9]. Although none of our patients were infected, dura patch in the management of neo- nates with anterior abdominal wall defects was discon- tinued at our center. The success of bovine pericardium for valves and patch grafts in cardiac surgery seemed to be suitable in place of dura in anterior abdominal wall defects [10, 11]. Therefore, since 1999, bovine pericard patches (Tutopatch and Tutomesh-H, Tutogen Inc., Neunkirchen am Brand, Germany) were employed and have replaced the dura patches as the standard bioma- terial for the first-stage closure of anterior abdominal wall defects at our center. Patients and methods Patients At the Pediatric Surgical University Clinic Mu¨nster, 29 (100%) newborns with anterior abdominal wall defects were managed from January 1999 until December 2003. Twenty-one (72%) newborns presented with C. van Tuil (&) Æ A. K. Saxena Æ G. H. Willital Pediatric Surgical University Clinic Mu¨nster, Munster, Germany E-mail: pediatricsurgery@web.de Tel.: +49-251-8347724 Fax: +49-251-8347716 C. van Tuil Klinik fu¨r Kinder- und Neugeborenenchirurgie, Westfa¨lische Wilhelms Universita¨t, Albert-Schweitzer-Straße 33, Mu¨nster, 48149 Germany E-mail: pediatricsurgery@web.de Tel.: +49-251-8347724 Fax: +49-251-8347716 Hernia (2006) 10: 41–47 DOI 10.1007/s10029-005-0037-3