Surgical wounds

Some liver allograft recipients will have open, healing skin incisions up to several months following transplantation. Many skin wounds are deliberately left open because of intercurrent wound infection. Liver allograft recipients are prone to wound infection for various reasons. These patients have depressed immune systems before transplantation and may have intercurrent and systemic infections prior to transplantation. The liver transplantation procedures entail opening the GI tract (either biliary or intestinal or both) with its unavoidable bacterial contamination. Furthermore, the patient is given immunosuppressive medications following the procedure. All of these facts are significant risk factors for wound infection.  Clinical findings of wound infections can be very subtle in the liver allograft recipient, and documentation of the absence of wound infection in the early postoperative period requires opening the wound down to the fascia in several areas along the length of the surgical incision.

The xiphoid extension of the bilateral subcostal "transplantation incision" is always left open including the fascia. This produces the "Williams window," which allows easy access to the liver allograft for safe, liver allograft biopsies. This area will scar over in the ensuing two months to allow future protocol core liver biopsies through this window during the late postoperative period. It is this area that is recommended for liver allograft biopsy sampling.