USE OF POLYTETRAFLUOROETHYLENE PATCH FOR TEMPORARY WOUND CLOSURE AFTER PEDIATRIC LIVER-TRANSPLANTATION

Despite numerous options for pediatric transplantation, closure of the abdominal wall after liver transplantation is occasionally difficult, resulting in increased abdominal pressure and possible vascular compr omise. Since 1990, we have utilized a 2 mm thick sheet of polytetraflu oroethylene (PTFE) to overcome this situation in 21 transplants for 17 patients. The median age was 0.9 months. Ten of the 21 transplants ut ilized full-size grafts. The donor to recipient weight ratio was 1.7+/ -1.2. Cadaveric left lateral segments were used in 8 of 21 transplants (weight ratio, 7.4+/-5.9), living donor left lateral segments were us ed in 3 of 21 transplants (weight ratio, 13.2+/-6.7). We were able to remove 14 of 21 patches with one additional operation, whereas 4/21 pa tches required two operations and 3/21 required three operations. Reop erations identified two cases of hepatic artery thrombosis not previou sly identified by duplex ultrasonography. There were no technical prob lems or adverse effects associated with the use of the PTFE patch. Aft er patch removal, the fascia was closed with a nonabsorbable suture an d the skin was allowed to close by secondary intention. There were no wound infections, portal vein thrombosis, or fluid and electrolyte abn ormalities. PTFE is a safe, temporary alternative to primary wound clo sure in liver transplantation when the size of the graft or intestinal and graft edema does not allow conventional closure of the abdomen. I nfectious, fluid/electrolyte, or ventilatory complications were not no ted. The necessity of a second-look operation is useful in assessing t he graft and vascular patency, The majority of patches can be removed within the first postoperative week.