{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T19:00:53Z","timestamp":1780254053290,"version":"3.54.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":150,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Pediatric liver transplantation (LT) with large\u2010for\u2010size (LFS) grafts frequently necessitates open abdomen (OA) management due to donor\u2013recipient graft size mismatch, increasing the risk of delayed closure and frequently requires the use of permanent prosthetic materials, together compounding the risk of postoperative infection. This study evaluates the safety and effectiveness of the Topaz\u2013Gurevich Doppler\u2010guided controlled\u2010closure technique (DGCT) in facilitating early primary abdominal closure without graft size reduction or the use of permanent prosthetic implants. A retrospective review was conducted at Schneider Children\u2019s Medical Center (2016\u20132024), including 21 pediatric LT recipients requiring OA management, primarily due to LFS grafts. DGCT integrates a tension relief system (TRS) for gradual abdominal wall approximation, guided by real\u2010time Doppler ultrasound to monitor perfusion and modulate closure tension, and is complemented by regulated, oxygen\u2010enriched irrigation and negative pressure\u2013assisted wound therapy to optimize the local wound environment. All patients achieved primary abdominal closure within a median of 8\u2009days (range, 2\u201323); only the first three cases required the temporary use of prosthetic materials. The median PICU and hospital stays were 17 and 35\u2009days, respectively. No cases of graft failure, retransplantation, or mortality occurred. One patient developed sepsis related to a bowel leak and fully recovered. DGCT proved safe and effective in managing OA in pediatric LT, avoiding permanent prosthetic implantation, and enabling early closure while maintaining graft perfusion. Its combined approach of mechanical tension control and enhanced local wound conditions reduces the need for graft size reduction, minimizes infection risk, and may broaden the donor pool. Based on high\u2010risk cases involving immunosuppressed children with significant graft\u2013recipient mismatch, these findings support DGCT as a valuable strategy for pediatric transplantation. Moreover, the principles demonstrated here may be extrapolated to the closure of complex OA scenarios across broader pediatric and adult surgical populations.<\/jats:p>","DOI":"10.1155\/joot\/9317796","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T18:31:28Z","timestamp":1780252288000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safe and Early Primary Closure of Open Abdomen in Pediatric Liver Transplantation Using a Doppler\u2010Guided Tension Relief Strategy and Enhanced Wound 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