Use of a Living Dermal Equivalent for a Refractory Abdominal Defect after Pediatric Multivisceral Transplantation

Abstract

Reepithelialization can be aided in the postoperative period in pediatric multivisceral transplant patients with human fibroblast-derived dermis, thereby helping to deter complications associated with secondary wound closure. We have illustrated the successful use of a human fibroblast-derived dermis as an adjunct for wound healing in a complicated surgical defect.

Repair of huge incisional hernias intentionally made during infantile living donor liver transplantation

“…Although a bioengineered skin equivalent has been reported for management of difficult abdominal skin defects after multivisceral transplantation in the pediatric generation, it is not available in all institutions [8]. Use of dermal homografts has also been reported as a tool for wound closure, but this is not possible in LDLT [9]. Skin closure leaving an incisional ventral hernia is an alternative method for wound closure in cases with large-for-size grafts.…”

The Closure of a Large Chronic Abdominal Wound in a Neonate Utilizing a Biologic Dressing

“…A complete treatment with Dermagraft, including the multiple applications, may actually be more cost-effective because of decreased wound healing time. 1 In the pediatric case reported by Charles et al, 8 5 Dermagraft applications were used over the course of 8 months. In this reported case, 1 application of 2 Dermagraft sheets led the chronic wound to heal within 2 months, suggesting that fewer applications may lead to a similar outcome.…”

“…To the authors' knowledge, use of Dermagraft in a pediatric abdominal wound has been previously reported only in a patient with multivisceral transplantation. 8 In clinical studies evaluating Dermagraft for the treatment of ulcers in diabetic patients, the product was applied weekly up to 8 applications. 4,9 The manufacturer's instructions also recommend weekly applications.…”

The use of human acellular dermis in the operative management of giant omphalocele

“…Its use has also been reported in the delayed closure of giant omphalocele associated with cloacal exstrophy [8]. As a nonimmunogenic material, it is fully incorporated by the body with low infectious risk [4,7], yet it does not incite the formation of dense adhesions [9], and its tensile strength is better then that of synthetic graft materials [10]. Most pertinent to its use in the repair of giant omphalocele is the potential for closure of the abdominal wall without cardiopulmonary compromise or additional loss of abdominal domain.…”

“…Human acellular dermis (AlloDerm) has been used as a fascial substitute in several types of abdominal wall reconstructions in both adults and children [3][4][5][6][7]. Its use has also been reported in the delayed closure of giant omphalocele associated with cloacal exstrophy [8].…”