Use of negative-pressure wound therapy and split-thickness skin autograft to cover an exposed renal transplant

Abstract

Exposure of a renal transplant through the abdominal wall is a rare event. A search of the literature reveals only six documented cases which used skin autograft for coverage, with none reported since 1981, and none which used negative-pressure wound therapy (NPWT) to prepare the recipient bed. This case report demonstrates that NPWT followed by split thickness skin graft is a reconstructive option which is feasible in patients who are at high risk for surgical complications in prolonged flap surgery.

Challenges in the Management of Kidney Allograft Herniation With a Single-stage Pedicled Anterolateral Thigh Flap

“…The fourth article presented a patient treated with STSG over the kidney after several months of wound preparation with negative pressure wound therapy (NPWT). 9 Although STSG is a safe and simple procedure, and it is, nonetheless, a weak option in this modern era of microsurgery. First, in order for an STSG to survive, the wound needs to be ready and showing signs of granulation, prolonging the duration of allograft exposure.…”

“…First, in order for an STSG to survive, the wound needs to be ready and showing signs of granulation, prolonging the duration of allograft exposure. McKinnon et al 9 introduced NPWT as a tool to reduce the duration of exposure, and it took 134 d before achieving the kidney allograft coverage. Second, restoring the defect by using a STSG neither restores the abdominal continuity nor provides an adequate soft tissue over the allograft.…”

“…When the authors reviewed the literature, there were only scant reports of its management, with the majority of the report proposing a somewhat outdated approach to the condition. [6][7][8][9] In addition, it was not clear what the optimal timing of the soft-tissue coverage is. This case report presents the authors' experience in managing an exposed, herniated kidney allograft with aggressive debridement and immediate reconstruction of the abdominal fascia and soft-tissue defect with a pedicled anterolateral thigh (ALT) fasciocutaneous flap.…”