Use of Polytetrafluoroethylene Patch for Temporary Wound Closure After Pediatric Liver Transplantation

Seaman, David; Newell, Kenneth A.; Piper, James; Bruce, David S.; Woodle, E. Steve; Cronin, David; Alonso, Emilio Ridruejo; Whitington, Peter F.; Thistlethwaite, J. Richard; Millis, J. Michael

doi:10.1097/00007890-199610150-00027

Cited by 37 publications

(18 citation statements)

References 8 publications

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“…Despite a variety of closure options in pediatric transplantation cases to approximate the wound edges, over 10% of pediatric liver recipients below the age of 3 required use of a temporary patch after transplantation, 10 and one third of pediatric and adult patients required several technical modifications in order to achieve anatomic and functional abdominal wall closure. 11 Because of the nature of the surgery and volume of grafted tissues, in multivisceral transplantation in pediatric patients, failure to achieve primary closure is even greater.…”

Section: Discussionmentioning

confidence: 99%

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Use of a bioengineered skin equivalent for the management of difficult skin defects after pediatric multivisceral transplantation

Drosou

Kirsner

Kato³

et al. 2005

Journal of the American Academy of Dermatology

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Section: Discussionmentioning

confidence: 99%

“…Temporary wound closure using prosthetic material is a common approach. 10,12,13,14 This may provide temporization until primary closure can be effected, 15 but does not provide an impetus for healing. Despite this, cases exist where approximation of the wound edges cannot be achieved and wounds close by secondary intention.…”

Section: Discussionmentioning

confidence: 99%

Use of a bioengineered skin equivalent for the management of difficult skin defects after pediatric multivisceral transplantation

Drosou

Kirsner

Kato³

et al. 2005

Journal of the American Academy of Dermatology

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“…This may be avoided in some circumstances by skin closure over an open fascia or use of a synthetic patch. 5,18 More than half of early reoperations in neonatal OLT recipients are performed for secondary abdominal closure. 4 The impact of these complications should not be underestimated; an oversized graft often triggers a series of events that ultimately leads to graft failure and patient mortality.…”

Section: Donor Considerationsmentioning

confidence: 99%

Liver transplantation in neonates

Sundaram

Alonso

Whitington

2003

Liver Transplantation

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Orthotopic liver transplantation (OLT) has evolved over the past two decades to become the standard of care for end-stage liver disease in infants and children. Technical advances, particularly the use of technical variant allografts, have permitted extension of OLT into a much younger and smaller population than previously possible. Major centers around the world now routinely perform OLT in infants with survival success equivalent to that in older children and adults. We are beginning to see a small population of school-aged children who were infant OLT recipients. The further extension of OLT into neonates is more recent, with only a few pediatric centers reporting survival success. Very little is known about this frontier of transplantation. Our intent is to provide an overview of neonatal OLT using all available data and our experience in the field. (Liver Transpl 2003;9:783-788.)F or the purpose of this review, neonatal orthotopic liver transplantation (OLT) is defined as transplantation performed in the first three months of life. This does not coincide with the usual definition of the neonate, infants in their first month of life. The extension to three months is necessary, however, because of the manner in which data regarding pediatric OLT have been collated. This division also holds because most diseases necessitating neonatal OLT produce liver failure at or near the time of birth. United Network for Organ Sharing (UNOS) data show that in 2001, 623 pediatric OLTs were performed in the United States. Of these transplantations, 167 were performed in children younger than one year of age and only eight in neonates. The number of neonatal OLT procedures has been varied over the past four years from eight to 14, with the peak in 2000. Patient and graft survival, 57% and 38% respectively, remain significantly lower than that of older children. 1,2 UNOS data show that infants three to 12 months old have graft and patient survival of 72.8 % and 82.1%, respectively. Children aged one to five years have 76.8% graft and 84.1% patient survival, and those older than six years have greater than 82% graft and 91% patient survival. These data demonstrate that transplantation in neonates presents unique medical and technical challenges. The complexities of liver transplantation in this age group have received relatively little attention in the medical literature. This review details the common indications for transplantation, addresses the multiple obstacles to successful transplantation, and explores strategies to improve survival and long-term outcomes in neonatal recipients. Defining the ProblemThe age distribution of reported neonatal OLTs is evenly distributed across the first three months of life. Woodle et al reported a series of 23 neonatal OLTs performed at three US centers: 28% were less than one month old, 35% were one to two months old, and 36% were two to three months old at the time of transplantation. 2 The youngest infant reported to undergo liver transplant was five days old. 3 The typical body weight...

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“…This is further supported by the marked improvement in liver function after decompressive laparostomy and Doppler ultrasound examinations, which showed patent arterial and portal liver vessels. The incidence of portal vein and hepatic artery thrombosis is elevated in the presence of increased intraabdominal pressure, underlining the need for an early diagnosis in such patients 15…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome after liver transplantation

et al. 2004

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The abdominal compartment syndrome is a well-known complication after abdominal trauma and is increasingly recognized as a potential risk factor for renal failure and mortality after adult orthotopic liver transplantation (OLT). We present a case report of a young patient who presented with acute liver failure complicated by an acute pancreatitis. The patient developed an acute abdominal compartment syndrome after OLT. Transurethral measurement of intraabdominal pressure indicated an abdominal compartment syndrome associated with impaired abdominal vascular perfusion, including liver perfusion. Renal insufficiency was immediately reversed after decompressive bedside laparotomy. The abdominal compartment syndrome is a potential source of posttransplant renal insufficiency and liver necrosis in OLT. It remains, however, a rarely described complication after liver transplantation, despite the presence of significant factors that contribute to elevated intraabdominal pressure. (Liver Transpl 2005;11:98-100.)T he abdominal compartment syndrome was first described more than 60 years ago by Ogilvie during World War II 1 and is defined as an organ injury caused by an acute increase in intraabdominal pressure. 2 It results in a compromised vascular supply to abdominal organs followed by injury to the pulmonary, cardiac, and renal systems. 3 Situations that may contribute to abdominal hypertension, defined as a permanent elevation of intraabdominal pressure above 20 -25 mm Hg, include pancreatitis, bleeding, pneumoperitoneum, ascites, bowel edema, abdominal packing, and intraabdominal abscesses. 3 The abdominal compartment syndrome occurs primarily after major abdominal surgery and severe trauma. 4 Recent publications increasingly have documented intraabdominal hypertension as a source of postoperative mortality in orthotopic liver transplantation (OLT). 5 Case ReportA 20-year-old male patient was admitted to our center with a 2-week history of acute liver failure of unknown origin. The patient developed progressive encephalopathy, falling prothrombin activity to 24%, and hypovolemic shock within 4 days of admission. An intracranial probe showed a pressure of 15 mm Hg. His medical history was noncontributory, and serology for hepatitis B and C was negative.OLT was performed on the fifth day after admission. Total operative time was 370 minutes. A portosystemic bypass using the axillary vein was performed; the duration of vena cava and portal vein occlusion was 65 and 85 minutes, respectively. Intraoperative blood loss was approximately 2 L; 7500 mL fresh frozen plasma, 1500 mL red blood cell concentrate, and 4000 mL Ringer's solution were given intraoperatively. Intraoperative findings included a small, shrunken liver and calcification-saponification stains of the surrounding tissue, suggesting the coexistence of acute-necrotizing pancreatitis. We found fat tissue necrosis in the omentum and in the retroperitoneal space surrounding the pancreas, which further implied the presence of an acute pancreatitis. The intestines d...

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Use of Polytetrafluoroethylene Patch for Temporary Wound Closure After Pediatric Liver Transplantation

Cited by 37 publications

References 8 publications

Use of a bioengineered skin equivalent for the management of difficult skin defects after pediatric multivisceral transplantation

Use of a bioengineered skin equivalent for the management of difficult skin defects after pediatric multivisceral transplantation

Liver transplantation in neonates

Abdominal compartment syndrome after liver transplantation

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