Background: Complex wound management in solid organ transplant recipients presents several challenges due to impaired tissue healing resulting from chronic immunosuppressive therapy. Although some studies suggest prolonged cadaveric skin graft survival in appropriately selected immunosuppressed patients, the long-term efficacy of this approach remains unclear.
Case report: Two solid organ transplant recipients experienced delayed failure of cadaveric skin grafts, highlighting the potential role of alternative wound management strategies over traditional autologous split-thickness skin grafting. A 59-year-old male with end-stage renal and liver disease who underwent a liver-kidney transplant 3 months prior presented with a hematoma and overlying skin necrosis to his lower extremity. After serial debridements, a 25 cm × 9 cm cadaveric skin graft was applied along with negative pressure wound therapy; despite initial adherence, the allograft subsequently failed by 4 weeks post-procedure. A 62-year-old male with a history of diabetes-related renal disease and liver-kidney transplant 6 years prior presented with a necrotizing soft tissue infection to his lower extremity. After serial debridements, a 28 cm × 12 cm cadaveric graft was applied. The allograft initially adhered, but it gradually disintegrated by 8 weeks post-procedure. During close clinical follow-up, both patients declined subsequent split-thickness skin grafting in favor of continued local wound care.
Conclusion: These cases underscore the unpredictable long-term efficacy of cadaveric skin grafting in chronically immunosuppressed patients, emphasizing the need for extended follow-up and improved wound healing strategies in this patient population.
Keywords: allograft; cadaveric skin graft; immunosuppression; soft tissue injury; transplant; wound.