Abstract
Incidence and Timing of Clamshell Wound Revisions After Bilateral Lung Transplantation: Institutional Experience with a Standardized Closure Technique
The Journal of heart and lung transplantation, v 45(5), pp 513-513
Apr 2026
Abstract
Purpose: The clamshell incision enables excellent exposure for bilateral lung transplantation (BOLT) but has fallen out of favor due to concern for a greater wound complication rate than bilateral thoracotomies. We reviewed our institutional experience to determine the incidence and timing of clamshell wound revisions and to describe our standardized closure technique, which we believe contributes to low complication rates.
Methods: All adult BOLT procedures performed after implementation of the CareConnect electronic health record (April 2013 - present) were reviewed. Among 614 unique cases, procedures labeled as wound revision within 60 days of transplant were identified from our institutional perioperative data warehouse. Each case was manually reviewed to verify relation to the clamshell incision. Descriptive statistics were used to calculate incidence and timing.
Results: Seventeen patients (2.8 %) were flagged as returning to the operating room for wound revision within 60 days. Of these, seven were confirmed as clamshell wound complications, yielding an incidence of 1.14 %. The mean and median times to reoperation were 39.9 and 37 days, respectively. The remaining ten revisions involved delayed chest closure (3) or hematoma evacuation (7) were excluded. Our closure method—a modified transsternal Robicsek using cables and sternal wires with de-tensioning pericostal sutures and cables and standardized skin staples with superficial wound vac—has been used consistently since prior to 2013.
Conclusion: Clamshell wound complications requiring reoperation occurred in 1.14% of BOLT recipients, typically 5-6 weeks postoperatively. The low incidence observed may relate to our standardized closure technique, which emphasizes rigid support and tension distribution across the thoracosternotomy.
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Details
- Title
- Incidence and Timing of Clamshell Wound Revisions After Bilateral Lung Transplantation: Institutional Experience with a Standardized Closure Technique
- Creators
- M. Daniel - University of California, Los AngelesT. Wingert - Department of Anesthesia, UCLA, Los Angeles, CAM. Fischer - Department of Anesthesia, UCLA, Los Angeles, CAJ. Song - University of California, Los AngelesS. McKay - University of California, Los AngelesH. Zappacosta - University of California, Los AngelesP. Cho - Drexel UniversityA. Abramov - University of California, Los AngelesJ. White - University of California, Los AngelesD. Telesca - University of California, Los AngelesA. Ardehali - University of California, Los Angeles
- Publication Details
- The Journal of heart and lung transplantation, v 45(5), pp 513-513
- Conference
- 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), 46th (Toronto, Ontario, Canada, 22 Apr 2026–26 Apr 2026)
- Publisher
- Elsevier Inc
- Number of pages
- 1
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001761532600033
- Other Identifier
- 991022189167604721