Delayed chest wall closure for oversized donor lungs after bilateral lung transplantation.

A 17-year-old boywith bilateral bronchiectasis was admitted for bilateral lung transplantation (BLTx). Chest radiography (CXR) demonstrated localized right pneumothorax, diffuse bronchiectasis with fibrosis, and a large bullous formation of the bilateral lungs (Fig. 1A), as well as severe thoracic kyphosis, a long-term consequence of maintaining his sitting posture in bed (Fig. 1B). Although the body weight, height, and chest circumference of the donor (65 kg, 162 cm, and 74 cm) and recipient (40 kg, 167 cm, and 76 cm) were wellmatched in the latter two attributes, the shapes of their respective thoracic cavities were quite different (Fig. 1C). A BLTx was performed through a clamshell incision, and the ischemic times for the left and right graft were 265 minutes and 440 minutes, respectively. Profound graft edema occurred immediately after the implantation of the donor lungs, which worsened the size disparity that was already present because of the mismatched lung volumes between the donor and the recipient. Rather than closing the chest wall, the skin was temporarily closed using a Slush Plain Drape (Mnlase Inc., Reston, USA), which was sewn to the skin using a running suture. An Ioban drape (3M, St. Paul, Minnesota) was then placed over the wound (Fig. 1D), and the patient was sent back to the intensive care unit for