封闭负压引流对肉芽成纤维细胞生物学行为的影响

目的 观察封闭式负压引流技术(VSD)对创面肉芽组织中成纤维细胞生物学行为的影响.方法 制作幼猪急性感染(绿脓杆菌感染模型)创面模型,设封闭负压引流治疗的为VSD组,常规换药治疗为对照组;观察创面肉芽组织成纤维细胞密度、胶原纤维数量、Ⅰ型/Ⅲ型胶原纤维比例和创面愈合时间,进行统计学比较.结果 VSD组成纤维细胞密度显著高于对照组(P＜0.01),胶原纤维数量显著高于对照组(P＜0.01),创面愈合时间明显短于对照组(P＜0.01).结论 封闭式负压引流能明显促进创面肉芽组织成纤维细胞的增殖,改善成纤维细胞胶原结构组成,缩短创面愈合时间.     

重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条促进肛瘘术后创面修复的临床观察

目的探讨重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条在肛瘘术后换药的疗效。方法将100例患者随机分为观察组和对照组各50例,观察组采用重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条换药,对照组单纯采用紫草油纱条换药。比较两组脓腐脱尽时间及创面愈合时间,术后第2、7、15天的创面分泌物、创面肉芽生长及创面疼痛积分。结果观察组的脓腐脱尽时间及创面愈合时间均短于对照组(P0.05),两组术后第2d的创面分泌物、创面肉芽生长及创面疼痛情况比较差异无统计学意义(P0.05),观察组术后第7、15d的各项积分均低于对照组(P0.05)。结论重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱能有效地促进肛瘘术后创面的愈合。     

PRP联合外用重组人碱性成纤维细胞生长因子治疗烧伤慢性创面效果观察

目的：探究富血小板血浆（Plateletrichplasma,PRP）联合外用重组人碱性成纤维细胞生长因子治疗烧伤慢性创面效果。方法：回顾性分析梧州市红十字会医院2019年12月-2021年12月收治的120例烧伤慢性创面患者资料，按照治疗方法不同分为观察组（n=64）和对照组（n=56），对照组给予外用重组人碱性成纤维细胞生长因子喷洒创面，观察组采用自制PRP与重组人碱性成纤维细胞生长因子粉剂配置的混合液喷洒或外涂创面，并观察两组患者创面愈合率和愈合时间、瘢痕增生情况、血清炎性因子和并发症情况。结果：观察组患者的创面愈合时间低于对照组（P<0.05），观察组的创面愈合率为96.88%，高于对照组的85.71%(P<0.05)。观察组治疗后1、3、6、12个月的温哥华瘢痕量表（Vancouverscar scale,VSS）评分值低于对照组（P<0.05）。治疗后，两组患者的C-反应蛋白和白细胞计数水平均降低，且观察组低于对照组（P<0.05）。观察组的并发症发生率为3.13%，显著低于对照组的16.07%(P<0.05)。结论：PRP联合外用重组人碱性成...     

负压辅助临时关腹技术用于腹腔开放合并肠空气瘘临床价值研究（附45例报告）

目的 研究腹腔开放合并肠空气瘘时应用负压辅助关腹（VAC）技术的可行性和对腹腔开放预后的影响。 方法 回顾性分析2012年2月至2015年2月南京军区南京总医院普通外科肠瘘治疗中心收治的45例肠瘘导致严重腹腔感染行腹腔开放治疗病人的临床资料。比较采用负压辅助关腹VAC和聚丙烯补片PPM关腹的治疗效果。结果 腹腔开放合并肠空气瘘时应用VAC技术可以明显缩短从腹腔开放到创面植皮的时间、ICU治疗时间和总住院时间,提高远期筋膜关腹率。结论 VAC技术是腹腔开放合并肠空气瘘的有效处理方式。     

成纤维细胞生长因子结合蛋白在烧伤后肉芽组织和增生性瘢痕中微血管形成的作用

目的探讨成纤维细胞生长因子结合蛋白（FGF—BP）mRNA在烧伤后肉芽组织和增生性瘢痕组织中的表达及其与微血管形成之间的关系。方法设计地高辛标记的FGF-BP寡核苷酸探针，对10例烧伤后肉芽组织，33例增生性瘢痕和9例正常皮肤进行原位杂交实验，检测各组织中FGF-BPmRNA的表达差异；采用免疫组织化学方法检测各组织中微血管数目差异。结果烧伤后肉芽组织组和增生性瘢痕（〈6个月）FGF-BPmRNA表达明显升高，FGF-BPmRNA在增生性瘢痕6个月后逐渐下降至正常水平。肉芽组织组和增生性瘢痕（〈6个月）微血管数目明显高于其他各组。FGF-BPmRNA表达与微血管数目成正相关（Spearman R=0．463，P〈0．01）。结论FGF．BP可能是影响烧伤后创面愈合和早期瘢痕增生过程中微血管形成的重要因子。     

暂时性腹腔关闭与常规关腹技术治疗严重腹腔感染的临床对比

目的观察暂时性腹腔关闭(temporary abdominal closure,TAC)与常规关腹技术在严重腹腔感染中的临床效果。方法回顾性分析2010年3月~2014年7月15例严重腹腔感染的临床资料,其中8例采用负压封闭引流关闭系统(vacuum sealing drainage,VSD)行暂时性关腹,7例常规关腹。比较2组术后腹内压变化、创面愈合时间、术后并发症等。结果常规关腹组术后72 h内腹内压逐渐升高,术后6~72 h各监测的时间点均高于暂时性关腹组(P0.01)。暂时性关腹组术后腹内压变化相对平稳(波动在7.7~18.1 mm Hg之间),创面愈合早[(11.3±1.8)d vs.(19.4±6.7)d,t=-3.142,P=0.005],切口感染少[12.5%(1/8)vs.100%(6/6),P=0.005]。结论暂时性腹腔关闭技术在治疗严重腹腔感染中能有效地预防腹内压升高,促进创面愈合,减少术后并发症,疗效确切。     

VSD联合胰岛素溶液局部冲洗治疗慢性创面的疗效观察

目的观察封闭式负压引流(vacuum sealing drainage,VSD)联合胰岛素溶液局部冲洗治疗慢性创面的疗效。方法选择2012年1月-2018年12月收治的60例慢性创面患者,按住院先后分为VSD组(A组)、生理盐水+VSD组(B组)、胰岛素溶液+VSD组(C组),每组20例。3组患者性别构成、年龄、病程、创面面积、创面深度等一般资料比较,差异均无统计学意义(P 0.05),具有可比性。清创后A组行VSD持续引流治疗,B组和C组分别行VSD持续引流加等量的生理盐水或胰岛素溶液间断冲洗治疗。治疗期间监测每日引流组织行成纤维细胞生长因子-2(FGF-2)、肿瘤生长因子α(TNF-α)、α-平滑肌肌动蛋白(α-SMA)含量;计算治疗6 d后肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率;治疗6 d后取创面肉芽组织行HE和Masson染色病理学观察。结果治疗6 d后C组肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率均明显高于A、B组(P0.05)。与A组相应时间点比较,B组FGF-2、α-SMA含量明显增高,TNF-α含量明显下降(P0.05);与B组比较,C组FGF-2、α-SMA含量明显增高,TNF-α含量明显下降(P0.05)。病理结果:A组治疗后新生毛细血管、成纤维细胞及胶原蛋白较少;B组新生毛细血管、成纤维细胞及胶原蛋白较多;C组大量新生毛细血管、成纤维细胞及胶原蛋白。结论 VSD联合胰岛素溶液局部冲洗治疗慢性创面可促进肉芽组织生长,加速创面修复,显著提高创面愈合率和愈合速度。     

重组人碱性成纤维细胞生长因子对老年腹股沟疝患者开放修补术后切口愈合的影响

目的观察重组人碱性成纤维细胞生长因子对老年腹股沟疝患者开放修补术后切口愈合的影响。 方法选取2019年1至12月南通市中医院开放腹股沟疝修补术后老年患者90例,按随机数字表法分为治疗组和对照组,每组各45例。其中治疗组术后即予重组人碱性成纤维细胞生长因子外敷,对照组常规换药。观察患者切口愈合时间、瘢痕长度、切口并发症发生率及瘢痕平整率。 结果治疗组切口愈合时间、瘢痕长度、切口并发症发生率、瘢痕平整率均优于对照组,差异均有统计学意义（P<0.05）。2组均未见不良反应。 结论老年腹股沟疝患者行开放腹股沟疝修补术后切口外用重组人碱性成纤维细胞生长因子能够显著缩短愈合时间,减少伤口并发症发生率,改善瘢痕外观,且安全有效。     

腹腔开放治疗肠瘘并严重腹腔感染73例分析

目的 研究腹腔开放治疗肠外瘘并腹腔感染的时机、方法与效果。比较不同暂时关腹技术,研究消化道与腹壁重建的时机与效果。方法 回顾性分析1999年1月至2008年12月南京军区南京总医院73例接受腹腔开放疗法的肠外瘘并严重腹腹腔感染的临床资料。结果 56例（76.7%）行腹腔开放疗法后存活（存活组）,10例（13.7%）死亡,7例（9.6%）放弃治疗（死亡及放弃治疗者统称为死亡及放弃治疗组）。死亡原因主要是腹腔出血（5例）、感染和脏器功能衰竭（5例）。腹腔开放前的APACHE II评分在存活组和死亡及放弃治疗组分别为13.5±4.3和16.0±5.8,腹腔开放后第5天时分别降至9.2±4.5和12.9±5.5;腹腔开放第15天时,存活组APACHEII评分降至8.1±6.2,而死亡及放弃治疗组评分重新升高至腹腔开放前水平（16.3±11.8）。脏器功能障碍评分亦有类似变化。结论 腹腔开放可有效治疗肠外瘘并严重腹腔感染病人。在多脏器功能严重损害前及时行腹腔开放疗法可有效改善肠瘘并严重腹腔感染的疾病严重度。腹腔开放后第15天左右的疾病严重度可提示病人的转归。行腹腔开放的病人可分为暂时关腹、创面植皮和永久重建3个阶段。消化道与腹壁重建可同时进行。     

多种生长因子促糖尿病患者难愈合性创面愈合的临床研究

目的　观察多种生长因子治疗糖尿病难愈合性创面的临床效果,并探讨其可能的机制。方法　将７８ 例糖尿病患者分为三组,即生理盐水对照组、表皮细胞生长因子（ Ｅ Ｇ Ｆ）治疗组、血小板源伤口愈合因子（ Ｐ Ｄ Ｗ Ｈ Ｆ）治疗组。观察治疗后１～８ 周创面闭合指数、创面治愈率及组织形态学变化。结果　 Ｅ Ｇ Ｆ组、 Ｐ Ｄ Ｗ Ｈ Ｆ组的创面闭合指数、创面治愈率较对照组明显增加,其肉芽组织毛细血管与成纤维细胞增生、胶原沉积和表皮覆盖明显,尤以溃疡与正常组织交界处明显。组间比较发现, Ｐ Ｄ Ｗ Ｈ Ｆ的促愈合作用优于 Ｅ Ｇ Ｆ。结论　局部应用多种生长因子可治疗糖尿病难愈合性创面,生长因子单独或配伍使用是改善糖尿病患者创面愈合受阻的有效措施。     

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??Study on the effect of different temporary abdominal closed materials to wound healing after open abdomen ZHANG Wei-wei, REN Jian-an, CHEN Jun, et al. Clinical School of Nanjing University, Department of General Surgery, Nanjing General Hospital of Nanjng Military Command, PLA, Nanjing 210002, China Corresponding author??REN Jian-an, E-mail: jan@medmail.com.cn Abstract Objective To observe the basic procedure of wound healing after open abdomen and observe the effect of different temporary abdominal closed materials on wound healing. Method Rats were divided into four groups each have 6 animals. After 24h of induction of peritonitis and abdominal compartment syndrome, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques: group A, by 3-L sterile plastic bag; group B, by Polypropylene mesh; group C, by Polypropylene mesh plus GH; group D, by Polypropylene mesh plus bFGF. On 7th day after open abdomen, the granulation tissue was assessed pathologically, and to measure MVD, the thickness of granulation tissue and the count of fibroblast. Results MVD, the thickness of granulation tissue and the count of fibroblast were higher in Polypropylene mesh closure plus bFGF rats than other groups.??P<0.05??Conclusion Polypropylene can promote the wound healing of open abdomen. Local application GH and bFGF can more hasten growing of granulation tissue, and the effect of local application bFGF is the best.     

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis

Background Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections. Materials and methods Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day. Results The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group. Conclusion Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.     

Extended indications for polypropylene mesh closure of the abdominal wall

Over a two-year period (1982-1984) polypropylene (Marlex) mesh was used without closing the abdominal wound in 21 patients judged clinically likely to require further abdominal exploration. A total of 43 meshes were implanted. All 21 patients had more than one major laparotomy, median 3 laparotomies (range 2-7) for drainage of pus (76 per cent) and/or intestinal leakage (67 per cent). Definitive abdominal wound closure after removal of polypropylene mesh was either by delayed primary suturing (33 per cent) or consisted of split skin grafting on the granulating wound (24 per cent). Three wounds were left to granulate without skin grafting (14 per cent). Mortality in this group of patients was 29 per cent and no complications resulted directly from implantation of polypropylene mesh. Polypropylene mesh closure of the abdominal wall not only provides simple and rapid access to the abdomen but also allows free drainage and daily inspection for the development of fistulae or the seepage of pus which are indications for further exploration. In that the clinical outcome is relatively favourable in this group of critically ill surgical patients who required multiple laparotomies within a short interval, it is suggested that mesh closure of the abdominal wound is indicated whenever abdominal re-entry is judged probable or rational.     

Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications.

The acute replacement of full-thickness abdominal wall has been facilitated by polypropylene mesh (Marlex) (PPM), allowing debridement of nonviable tissue and restoration of abdominal wall integrity without tension. However, no substantial long-term follow-up has been reported on the definitive wound coverage after the use of PPM in open wounds. Since 1976, we have placed PPM in 31 patients; 25 for infectious complication, three for massive bowel distension preventing abdominal closure, and three for shotgun wounds with extensive tissue loss. In 29 of 31 patients, the mesh was placed in heavily contaminated wounds; extensive fasciitis was present in 23 patients and 21 had intra-abdominal abscesses. Following mesh placement, 23 reoperations were required for continuing complications. No patients eviscerated, despite these multiple procedures. Polypropylene mesh was highly effective in restoring abdominal wall continuity. Despite advantages when PPM was used, significant long-term problems developed. Seven patients died from their primary illness in the postoperative period. Nine wounds were closed by granulation and subsequent split-thickness skin grafts. All nine developed mesh extrusion and/or enteric fistulae. Nine wounds healed by secondary intention, six developed enteric fistulae or continuing mesh extrusion. Full-thickness flap coverage after granulation provided the best means of wound closure. Polypropylene mesh had significant early advantages for providing abdominal wall integrity even in the presence of severe infection. However, long-term problems were common when wounds were closed to skin grafts or secondary intention. If the mesh cannot be completely removed, strong consideration should be given to myocutaneous flaps for coverage after the primary illness has resolved.     

Complications after 344 damage-control open celiotomies

BACKGROUND: We reviewed our experience with the open abdomen and hypothesized that the known high wound complication rates were related to the timing and method of wound closure. METHODS: All trauma admissions from 1995 through 2002 requiring an open abdomen and temporary abdominal coverage were included. The study group was then classified by three wound closure methods used in survivors: 1) primary (primary fascial closure); 2) temporizing (skin only, spit thickness skin graft and/or absorbable mesh), and 3) prosthetic (fascial repair using nonabsorbable prosthetic mesh). RESULTS: In all, 344 patients required an open abdomen and temporary abdominal coverage either as part of a planned staged damage-control celiotomy (66%) or the development of the abdominal compartment syndrome (33%). Of these, 276 patients survived to wound closure. Sixty-nine of the 276 (25%) suffered wound complications (wound infection, abscess, and/or fistula). Thirty-four (12%) died after wound closure; seven of the deaths as a direct result of the wound complication. Complications increased significantly after 8 days (p < 0.0001) from the initial operative intervention to fascial closure. Primary fascial closure was achieved in 180 of 276 (65%) patients. Although there was no difference in the mean Injury Severity Score between the three groups, the primary group had significantly fewer mean transfusion requirements, shorter mean time to fascial closure, and a lower complication rate as compared with either the temporizing or prosthetic groups. The primary group thus incurred significantly less mean initial hospitalization charges. CONCLUSION: Morbidity associated with wound complications from the open abdomen remains high (25%). Morbidity is associated with the timing and method of wound closure and transfusion volume, but independent on injury severity. Also, delayed primary fascial closure before 8 days is associated with the best outcomes with the least charges.     

Effect of Temporary Abdominal Closure on Colonic Anastomosis and Postoperative Adhesions in Experimental Secondary Peritonitis

Background The effect of relaparotomies and temporary abdominal closure on colonic anastomoses and postoperative adhesions is under debate. Methods In the experiments reported here, colonic anastomosis was constructed 24 hours after cecal ligation and puncture in rats that were divided into three groups of eight animals each. The abdomen was closed primarily in groups I and II, and a Bogota bag was used for abdominal closure in group III. At 24 hours following anastomosis, relaparotomy was performed only in group II and III rats, and the abdomen was closed directly in group II; after removal of the Bogota bag in group III animals, the abdomen was closed directly. On the fifth day of anastomotic construction, bursting pressures and tissue hydroxyproline content of the anastomoses, along with peritoneal adhesions, were assessed and compared. Results Mean anastomotic bursting pressures and hydroxyproline contents did not differ among the groups. Median adhesion scores were significantly higher in group III than the other two groups. Conclusions Relaparotomy and the type of temporary closure have no negative effect on anastomotic healing in rats with peritonitis. Temporary abdominal closure with a Bogota bag caused a significantly high rate of adhesions.     

Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction—A Novel Technique for Late Closure of the Open Abdomen

Background Open abdomen (OA) treatment often results in difficulties in closing the abdomen. Highest closure rates are seen with the vacuum-assisted wound closure (VAWC) technique. However, we have experienced occasional failures with this technique in cases with severe visceral swelling needing longer treatment periods with open abdomen. Feasibility and short-term outcome of a novel combination of techniques for managing the open abdomen are presented. Methods The VAWC technique was combined with medial traction of the fasciae through a temporary mesh in seven consecutive patients. The VAWC-system was changed and the mesh tightened every 2–3 days. Results Median (range) age in the 7 men was 65 (17–78) years. The diagnoses were ruptured abdominal aortic aneurysm (AAA) (3), operation for juxtarenal AAA (1), iatrogenic aortic lesion (1), trauma (1) and abdominal abscesses (1). Four patients were decompressed due to abdominal compartment syndrome (ACS) or intra-abdominal hypertension, and 3 could not be closed after laparotomy. Intra-abdominal pressure prior to OA treatment was 24 (17–36) mmHg. Maximal separation of the fasciae was 16 (7 –30) cm. Delayed primary closure was achieved in all patients after 32 (12–52) days with OA. No recurrent ACS was seen. No technique-specific complication was observed. Two small incisional hernias, one intra-abdominal abscess and one wound infection occurred in three patients. Conclusions Delayed primary closure in cases with severe visceral swelling and long periods of OA seems feasible with this technique.     

Evaluation of absorbable polyglycolic acid mesh as a wound support

The ideal wound-support material would reinforce a wound early in the healing process when intrinsic wound strength is the weakest, yet disappear over time, preventing many of the untoward late effects seen with currently utilized nonabsorbable materials. This study was designed to evaluate the effectiveness of a newly designed absorbable material, polyglycolic acid mesh (Dexon), as a buttress for abdominal wounds closed under moderate tension. Young male rats (n = 211) were divided into three experimental groups. Animals in groups 1 (n = 96) and 2 (n = 95) had a 1.2 cm2 midline abdominal wall defect created and closely primarily. Animals in group 2 had a 2 X 5 cm piece of polyglycolic acid mesh sutured to the anterior abdominal wall overlying the closed abdominal defect. Animals in group 3 (n = 20) were unoperated controls. The animals in groups 1 and 2 were killed 1, 2, 3, 4, and 5 weeks after surgery. The entire anterior abdominal wall was removed and placed upon a bursting strength testing device. Bursting strength determinations of the supported and unsupported abdominal closures revealed that the strength of the wounds reinforced with polyglycolic acid mesh was significantly greater than unsupported wounds at 1, 2, and 3 weeks after surgery. Wounds supported with mesh had bursting strengths similar to unoperated abdomens by the first postoperative week. This study demonstrates that abdominal wall defects in rats closed primarily develop increased wound strength when the closure is supported by absorbable polyglycolic acid mesh. The use of an absorbable material may alleviate potential late complications associated with implantation of nonabsorbable materials. The clinical application of such a material remains to be determined.     

人工材料修补老年腹壁切口疝的手术方法探讨

目的总结采用人工材料无张力修补腹壁切口疝的临床经验和方法，探讨人工材料置于腹壁不同的层次是否影响疗效。方法回顾性分析67例老年腹壁切口疝的手术方法、围手术期处理、术后并发症、引流的放置、抗生素的使用及随访结果。根据人工材料放置位置不同分为两组：前鞘前、腹膜前，比较两组间一期愈合和复发情况。结果患者平均年龄68．52岁；全部采用人工材料修补；人工材料分别放置于前鞘前（皮下）42例、腹膜前（肌层后）25例；术后放置负压吸引49例（73．13％），全部使用抗生素预防感染；术后皮下积液6例（8．96％），切口延迟愈合5例（7．46％），肺部感染5例（7．46％）；随访2．4年（0．5～4年），两组患者均无复发，两组间一期愈合率无显著差别。结论采用人工材料行无张力疝修补是合适的治疗老年腹壁切口疝的方法，人工材料置于腹壁不同层次均可取得良好疗效，良好的围手术期处理是疗效的重要保证。     

Temporary silastic mesh closure for adult liver transplantation: a safe alternative for the difficult abdomen.

Primary fascial closure is often difficult after adult orthotopic liver transplantation (OLT), complicated by donor-to-recipient graft size mismatch, post-reperfusion hepatic edema, coagulopathy, or intestinal edema. Attempts at closing the abdomen under these circumstances can cause increase in intra-abdominal pressures, resulting in significant complications, including graft loss. Temporary closure with silastic mesh has been used as a viable option in children receiving transplants, but there is no experience recorded with its use in adults. A retrospective review was conducted on 200 consecutive liver transplantations performed over 42 months (October 2002 to February 2006). Records were evaluated for patient and donor demographics, perioperative factors including Model for End-Stage Liver Disease and Child-Turcotte-Pugh scores, indications for OLT, ischemic times, blood product administration, and use of temporary silastic mesh closure. Patients requiring silastic mesh were further evaluated for indication, time to primary fascial closure, duration of intubation, length of stay, graft function, and complications (infectious, vascular, biliary, and hernia development). Comparisons were made with a cohort of patients undergoing OLT over the same time period but who were closed primarily, without the use of temporary silastic mesh. Fifty-one liver transplantations (25.5%) of the 200 total transplant cohort used silastic mesh closure. Comparison of the cohorts (primary closure vs. temporary mesh) revealed that no differences existed, except the requirement of all blood products was significantly greater in the silastic mesh group (P < 0.001). Bowel edema (47.1%) and coagulopathy (37.3%) were the most common indications for mesh closure, with less frequent reasons including donor to recipient size mismatch (11.8%), hemodynamic instability, and a large preexisting fascial defect (2.0% each). The average time from transplant to final fascial closure was 3.4 days (range 2-9 days). In the silastic cohort, 41 transplants where closed primarily, 3 required the addition of synthetic mesh, and 6 had component separation and flap closure. After fascial closure, the mean time to extubation was 1 day. The median length of follow-up was 1.3 years for the silastic closure group. Long-term wound complications in the silastic closure group included 1 instance of colonic fistula, 2 incisional hernias, and 2 wound infections. The 30-day and 1-year patient survival for this group were 93.6 and 82.4%, respectively, and the graft survival for those same periods were 90.2 and 77.7%, respectively. Wound complications, rates of hepatic artery thrombosis or stricture, portal vein thrombosis or stricture, biliary complications, and allograft and patient survival were no different than those in patients undergoing initial primary closure. In adult liver transplantation with a difficult (or potentially difficult) abdomen, temporary closure with silastic mesh was found to allow for uncomplicated fascial closure in a short period of time, with rapid extubation times, excellent graft function, and minimal instances of infectious or wound complications. In circumstances where large amounts of blood products are required, where a size mismatch exists, or where bowel edema is present during adult liver transplantation, temporary closure with silastic mesh is an ideal strategy.