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Updated: Jun 20, 2026
Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications
Published on: May 10, 2024
Wound complications in liver transplantation: effect of incision type and suture material
Tommy Wright1, Timothy Kouo1, Gregory J McKenna1
1Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA.
Background:
The superiority of incision type in liver transplant has yet to be clearly established.
Methods:
In this study, we reviewed all liver-only transplant recipients at the Simmons Transplant Institute from 2012 to 2018 and divided them based on two incision types: Mercedes (M) and hockey stick (HS).
Results:
A total of 765 patients met inclusion criteria: 278 had an M incision (36%) and 487 had an HS incision (64%). There was no difference between groups based on sex, age, body mass index, presence of ascites pretransplant, and prior open abdominal surgeries. After transplant, the incidence of fascial dehiscence and subsequent incisional hernia repairs between groups was the same. However, patients with an M incision had more wound infections (4.3% vs 1.2%, P = 0.007), required more wound vacuum-assisted closure device placements (25% vs 13%, P < 0.001), and had higher rates of washouts (25% vs 14%, P < 0.001). There was no difference in wound complications between the use of polydioxanone or polypropylene (Prolene) as the fascial closing suture of choice. Significant risk factors for the development of an incisional hernia included sex, age, and body mass index.
Conclusion:
Our results indicate that M incisions require greater postoperative wound care.
Insights
The Mercedes (M) incision in liver transplants led to more wound infections and required increased postoperative care compared to the hockey stick (HS) incision. No significant differences were found in hernia rates between the two surgical approaches.
Area of Science:
- Abdominal Surgery
- Transplant Surgery
- Surgical Incisions
Background:
- The optimal surgical incision for liver transplantation remains debated.
- Establishing the superiority of one incision type over another is crucial for patient outcomes.
Purpose of the Study:
- To compare the outcomes of Mercedes (M) and hockey stick (HS) incisions in liver-only transplant recipients.
- To identify differences in postoperative complications and wound healing between the two incision types.
Main Methods:
- Retrospective review of 765 liver transplant recipients from 2012-2018.
- Patients were categorized based on M or HS incision.
- Outcomes analyzed included wound infections, incisional hernia rates, and need for wound vacuum-assisted closure.
Main Results:
- No significant differences in fascial dehiscence or incisional hernia repair rates were observed between M and HS incisions.
- Patients with M incisions experienced higher rates of wound infections (4.3% vs 1.2%), wound vacuum-assisted closure device placements (25% vs 13%), and washouts (25% vs 14%).
- Sex, age, and body mass index were identified as significant risk factors for incisional hernia development.
Conclusions:
- Mercedes incisions are associated with increased postoperative wound complications and necessitate greater wound care.
- The choice of fascial closure suture (polydioxanone vs. polypropylene) did not impact wound complication rates.
