Use of a silastic® silo for closure of the abdominal wall in a pediatric patient receiving a cadaveric split liver

Jones, W. Tracey; Ratner, Irving A.; Abrahamian, Gregory A; Washburn, W.Kenneth; Esterl, Robert M.; Neigut, Deborah A.; Halff, Glenn A.

doi:10.1016/s0022-3468(03)00524-4

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…Many techniques have been described to best manage the open wound, including a silastic silo, the “sandwich” technique, complex plastic reconstructive methods, and simple skin closure. By and large, results obtained using these techniques have been very favorable 13–19…”

mentioning

confidence: 99%

Temporary silastic mesh closure for adult liver transplantation: A safe alternative for the difficult abdomen

Jafri¹,

Tevar²,

Lucia³

et al. 2007

Liver Transpl

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Primary fascial closure is often difficult after adult orthotopic liver transplantation (OLT), complicated by donor-to-recipient graft size mismatch, post-reperfusion hepatic edema, coagulopathy, or intestinal edema. Attempts at closing the abdomen under these circumstances can cause increase in intra-abdominal pressures, resulting in significant complications, including graft loss. Temporary closure with silastic mesh has been used as a viable option in children receiving transplants, but there is no experience recorded with its use in adults. A retrospective review was conducted on 200 consecutive liver transplantations performed over 42 months (October 2002 to February 2006. Records were evaluated for patient and donor demographics, perioperative factors including Model for End-Stage Liver Disease and Child-Turcotte-Pugh scores, indications for OLT, ischemic times, blood product administration, and use of temporary silastic mesh closure. Patients requiring silastic mesh were further evaluated for indication, time to primary fascial closure, duration of intubation, length of stay, graft function, and complications (infectious, vascular, biliary, and hernia development). Comparisons were made with a cohort of patients undergoing OLT over the same time period but who were closed primarily, without the use of temporary silastic mesh. Fifty-one liver transplantations (25.5%) of the 200 total transplant cohort used silastic mesh closure. Comparison of the cohorts (primary closure vs. temporary mesh) revealed that no differences existed, except the requirement of all blood products was significantly greater in the silastic mesh group (P Ͻ 0.001). Bowel edema (47.1%) and coagulopathy (37.3%) were the most common indications for mesh closure, with less frequent reasons including donor to recipient size mismatch (11.8%), hemodynamic instability, and a large preexisting fascial defect (2.0% each). The average time from transplant to final fascial closure was 3.4 days (range 2-9 days). In the silastic cohort, 41 transplants where closed primarily, 3 required the addition of synthetic mesh, and 6 had component separation and flap closure. After fascial closure, the mean time to extubation was 1 day. The median length of follow-up was 1.3 years for the silastic closure group. Long-term wound complications in the silastic closure group included 1 instance of colonic fistula, 2 incisional hernias, and 2 wound infections. The 30-day and 1-year patient survival for this group were 93.6 and 82.4%, respectively, and the graft survival for those same periods were 90.2 and 77.7%, respectively. Wound complications, rates of hepatic artery thrombosis or stricture, portal vein thrombosis or stricture, biliary complications, and allograft and patient survival were no different than those in patients undergoing initial primary closure. In adult liver transplantation with a difficult (or potentially difficult) abdomen, temporary closure with silastic mesh was found to allow for uncomplicated fascial closure in a short period of time, wi...

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mentioning

confidence: 99%

Temporary silastic mesh closure for adult liver transplantation: A safe alternative for the difficult abdomen

Jafri¹,

Tevar²,

Lucia³

et al. 2007

Liver Transpl

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“…15 Temporary abdominal closure using prosthetic materials has been reported in pediatric liver transplant. 16,17 Such prosthetic materials are associated with increased risk of infection. Bioengineered skin equivalents have also been used for management of large abdominal skin defects.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Soy

Kırnap²,

Yıldırım³

et al. 2017

Exp Clin Transplant

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“…Temporary abdominal closure using prosthetic materials has been reported in pediatric liver transplantation in infants with size-mismatched grafts [2][3][4][5][6][7]. Although the reported incidence is not very high, such artificial materials are associated with the risk of infectious complications under the immunosuppression status after transplantation.…”

Section: Discussionmentioning

confidence: 99%

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

Muroya

Inomata

Asonuma

et al. 2009

Journal of Pediatric Surgery

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Use of a silastic® silo for closure of the abdominal wall in a pediatric patient receiving a cadaveric split liver

Cited by 11 publications

References 13 publications

Temporary silastic mesh closure for adult liver transplantation: A safe alternative for the difficult abdomen

Temporary silastic mesh closure for adult liver transplantation: A safe alternative for the difficult abdomen

Untitled

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

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