Porcine acellular dermal matrix for delayed abdominal wall closure after pediatric liver transplantation
O Caso Maestro1, M Abradelo de Usera, I Justo Alonso
1Department and Institution, General Surgery and Abdominal Organ Transplantation, Hospital 12 de Octubre, Madrid, Spain.
Insights
Delayed abdominal wall closure using a biological mesh is effective in pediatric liver transplant patients when primary closure isn't possible. This approach ensures a functional abdominal wall, improving outcomes for young transplant recipients.
Area of Science:
- Pediatric Surgery
- Organ Transplantation
- Biomaterials Science
Background:
- Pediatric liver transplant (LT) recipients face high mortality rates, with abdominal wall closure posing a significant challenge.
- Size discrepancies between grafts and small pediatric recipients often preclude primary abdominal wall closure after LT.
Purpose of the Study:
- To evaluate the efficacy of delayed abdominal wall closure using a non-cross-linked porcine-derived acellular dermal matrix in pediatric LT patients.
- To assess the long-term functional outcomes of the abdominal wall following this reconstructive technique.
Main Methods:
- Retrospective cohort study involving six pediatric patients who underwent LT.
- Delayed abdominal wall closure was performed using a non-cross-linked porcine-derived acellular dermal matrix (Strattice™).
- Patients were followed for a mean of 26 months post-procedure.
Main Results:
- All six patients achieved delayed abdominal wall closure successfully.
- At a mean follow-up of 26 months, all patients were asymptomatic.
- Physical examinations confirmed a functional abdominal wall in all study participants.
Conclusions:
- Non-cross-linked porcine-derived acellular dermal matrix (Strattice™) represents a viable option for delayed abdominal wall closure in pediatric LT.
- The technique facilitates the restoration of abdominal wall function in challenging pediatric cases.
- Further randomized controlled trials are warranted to optimize timing and techniques for abdominal wall closure in this population.
Abstract:
Children are one of the groups with the highest mortality rate on the waiting list for LT. Primary closure of the abdominal wall is often impossible in the pediatric population, due to a size mismatch between a large graft and a small recipient. We present a retrospective cohort study of six pediatric patients, who underwent delayed abdominal wall closure with a biological mesh after LT, and in whom early closure was impossible. A non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) Reconstructive Tissue Matrix; LifeCell Corp, Bridgewater, NJ, USA) was used in all of the cases of the series. After a mean follow-up of 26 months (21-32 months), all patients were asymptomatic, with a functional abdominal wall after physical examination. Non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) ) is a good alternative for delayed abdominal wall closure after pediatric LT. Randomized controlled trials are necessary to determine the best moment and the best technique for abdominal wall closure.
