Description of past management: Our past management of abdominal wall defects was with the use of a permanent mesh which required multiple operations to culminate skin closure. This approach tookk several weeks requiring a prolonged ICU stay with an increased risk of co-infection.

Current clinical approach: Two patients were used in this case study one receiving liver small intestine and one multivisceral transplant. Both patients had incomplete closure of their abdominal domain following post operative complications and the inability to close the abdomen to avoid tension over the transplanted graft. The SIS wound matrix and a hydrofiber dressing was started on the first post operative day and continued until full wound closure was achieved. One patient was treated for a significant allograft rejection and maintained on corticosteroids throughout wound healing.

Patient outcomes: Both patients went on to achieve full closure without the need for surgical intervention. Complete closure of the abdominal defect occurred in as short as 8 weeks.

Conclusions: Pediatric abdominal recipients wait on the UNOS list longer than adults and the number of patients waiting has increased over the past decade. There is a potential for death while waiting for organs – this potential for mortality on the waiting list is highest for candidates waiting for combined liver-intestinal allografts.
The use of SIS allows the development of granulation tissue and contraction of full thickness surgical wounds.This allows pediatric transplant patients to heal quickly and likely reduces their length of ICU stay reducing their infection risk.