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The management of difficult abdominal closure after pediatric liver transplantation
1Queensland Liver Transplant Service, Royal Children's Hospital, Brisbane, Australia.
Insights
Temporary SILASTIC patch closure is a safe and effective method for pediatric liver transplant patients when primary abdominal wound closure is not feasible due to organ size or bowel distension. This technique facilitates eventual wound healing within two weeks.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Transplantation Surgery
Background:
- Liver transplantation in children presents unique surgical challenges.
- Abdominal wall closure can be difficult due to factors like graft size and bowel edema.
- Alternative wound management strategies are crucial for successful outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of temporary SILASTIC patch closure for pediatric liver transplant patients.
- To determine the outcomes associated with this technique when primary closure is not possible.
Main Methods:
- Retrospective analysis of 164 pediatric liver transplantations performed between 1985 and 1994.
- Identification of patients (21) requiring temporary SILASTIC patch closure for abdominal wounds.
- Documentation of the timeline for patch removal and final abdominal wall closure.
Main Results:
- Temporary SILASTIC patch closure was utilized in 21 pediatric liver transplant recipients.
- For 16 patients, wound closure was achieved by postoperative day 7.
- The remaining 5 patients had their wounds closed by the end of week 2.
Conclusions:
- Temporary SILASTIC patch closure is a viable and recommended option for pediatric liver transplant patients when primary abdominal closure is contraindicated.
- This method allows for staged abdominal wall closure, accommodating post-transplant physiological changes.
- The technique demonstrates a favorable timeline for wound healing and closure.
Abstract:
Between January 1985 and December 1994, 164 liver transplantations were performed on 141 children. There were 100 reduced-size and 64 whole-liver grafts. Primary closure of the abdominal wound was not possible in 21 patients because of liver size, bowel edema, and distension. Temporary SILASTIC patch closure of the abdominal wound was used. For 16 of the 21 patients, removal of the SILASTIC patch and abdominal wall closure were completed by the seventh postoperative day; for the others, these were accomplished by the end of 2 weeks. The method is recommended when primary wound closure is not possible.