Wound care of the transplant recipient poses a unique challenge to the wound care practitioner secondary to significant comorbidities which delay wound healing. Patient is an 18 month old former 24 week preemie, diagnosed with hepatoblastoma at 7 months of age. At time of transplant he plotted < 3 percentile for weight and 10-25 percentile for height. Medical history was complicated by significant lung disease secondary to bronchopulmonary dysplasia, and by receiving 5 courses of systemic chemotherapy prior to transplant. The patient received a cadaveric liver transplant on 8/28/06. Incomplete wound closure to avoid tension over the transplanted graft required a vicryl mesh closure with defect measuring 5.5 cm x 7.5 cm x 0.25 cm.

Description of past management:

The wound was treated post operatively with wet to dry dressing changes done daily but management of wound exudate became a predominant factor in the selection of wound care modalities.

Current clinical approach:

NPWT instituted on 9/5/06. After 2 weeks of NPWT therapy there were no significant changes seen in the wound bed. The SIS wound matrix was started on 9/18/06 and NPWT was continued to maximize wound healing.

Patient outcomes:

Results of the SIS matrix with the NPWT were positive. The wound was fully granulated after 4 weeks of therapy. The NPWT was stopped at this time and the wound measured 3 cm x 3.75 cm x <0.1 cm showing a 50% reduction in wound dimensions. SIS wound matrix continued until complete wound closure was achieved.

Conclusion:

This SIS wound matrix used in conjunction with NPWT was an effective approach to obtaining quick granulation and contraction of a full thickness surgical wound. Earlier wound closure may improve infection related morbidity in the transplant population.

Financial Assistance/Disclosure:

No financial assistance was received for this study.