CASE REPORT Use of a Living Dermal Equivalent for a Refractory Abdominal Defect after Pediatric Multivisceral Transplantation CARLOS A. CHARLES , MD, n T OMOAKI K ATO, MD, w ANDREAS G. T ZAKIS , MD, w B ARBARA N. MILLER, AND ROBERT S. K IRSNER, MD nz§ n Department of Dermatology and Cutaneous Surgery, z Department of Epidemiology and Public Health, and w Division of Transplantation/Department of Surgery, University of Miami School of Medicine, Miami, Florida; and § Veterans Administration Medical Center, Miami, Florida BACKGROUND. Primary closure is not always possible after pe- diatric multivisceral transplantation. Reepithelialization may require extended periods of postoperative time, which can be associated with significant morbidity OBJECTIVE. The objective was to accelerate secondary wound closure thereby minimizing infection or further complications in a pediatric multivisceral transplant patient. METHODS. Five applications of human fibroblast-derived de- rmis (Dermagraft, Smith and Nephew) were applied to the postsurgical defect of a pediatric multivisceral transplant pa- tient over the course of 8 months. Routine wound care and observation was performed between human fibroblast-derived dermis applications. RESULTS. Human fibroblast-derived dermis stimulated healing and accelerated reepithelialization. Signs of clinical rejection or infection were not observed. CONCLUSION. Reepithelialization can be aided in the postoper- ative period in pediatric multivisceral transplant patients with human fibroblast-derived dermis, thereby helping to deter com- plications associated with secondary wound closure. We have illustrated the successful use of a human fibroblast-derived dermis as an adjunct for wound healing in a complicated surgical defect. CARLOS A. CHARLES, MD, TOMOAKI KATO, MD, ANDREAS G. TZAKIS, MD, BARBARA N. MILLER, AND ROBERT S. KIRSNER, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. PRIMARY CLOSURE is not always possible after pe- diatric multivisceral transplantation. The inability to surgically close abdominal wall defects is usually a multifactorial phenomenon, secondary to oversized donor organs, contraction of the recipient abdominal wall from previous operations, anatomic defects due to external ostomies, and/or intestinal or graft edema. 1 The use of temporary patched closures, with progres- sive surgical reduction in patch size as reepithelializat- ion occurs, leading to an eventual staged closure is occasionally employed. Nevertheless, reepithelializat- ion of the open wound is often difficult in these phys- ically compromised patients, and complete wound closure may require extended periods of postoperative time, which can be associated with significant mor- bidity. Abdominal wall transplantation has recently been performed to compensate the abdominal wall defect in bowel transplant patients. 2 Nevertheless, the use of such transplantation is still in its early stages of evolution. The following case report describes a bed- side approach to stimulating epithelialization to accel- erate wound closure thereby minimizing infection or further complications in an immunocompromised patient. Case Report A 15-month-old white girl was born with gas- troschisis. She was the product of a spontaneous vag- inal delivery at 38 weeks estimated gestational age with a birth weight of 2157 g. She was taken to the operating room on the first day of life for treatment of the gastroschisis. At that time, the bowel remained viable; however, the abdominal wall opening was narrow, thereby constricting the mesenteric vascular pedicle. A silo (a temporary, artificial, abdominal wall to contain the intestines for gradual decompression) was placed to allow for easier insertion of the bowel into the abdominal cavity. At 5 days of age, she returned to the operating room for exchange of the silo and insertion of a subclavian Broviac catheter for parenteral nutrition. The bowel was subsequently returned to the abdominal cavity, a colostomy was r 2004 by the American Society for Dermatologic Surgery, Inc.  Published by Blackwell Publishing, Inc. ISSN: 1076-0512/04/$15.00/0  Dermatol Surg 2004;30:1236–1240 Address correspondence and reprint requests to: Robert S. Kirsner, MD, Associate Professor, Department of Dermatology and Cutaneous Sur- gery, University of Miami School of Medicine, 1201 NW 16th Street, B1206, Miami, FL 33125, or e-mail: RKirsner@med.miami.edu.