Skin autografts to cover exposed renal allografts

Exteriorized renal allografts that protrude abnormally after dehiscence of transplant wounds pose a rare but formidable surgical problem. If good renal allograft function is present and wound sepsis is controlled, the renal allograft need not be removed even if the wound cannot be approximated. The exposed kidney behaves like other body soft tissues, and resurfacing the renal cortex with skin autografts can be performed successfully. We present four cases demonstrating that split-thickness autografts can be successfully utilized to cover an exposed renal allograft with salvage of allograft function. The incidence of this situation was 0.62% in a series of 641 consecutive renal transplants. We also observed, incidentally, that there was no apparent linkage between the HL-A complex and the tendency for keloid formation.