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Tension-free muscle closure is essential in kidney transplantation, both in adult and pediatric patients. Tight muscle closure
may lead to renal allograft compartment syndrome either due to compression of the renal parenchyma or due to
kinking of the renal vessels. It may also cause kinking of the transplant kidney ureter, wound dehiscence and incisional
hernia. Many techniques have been proposed in an attempt to achieve tension-free closure. There is a wrong belief among
surgeons that using prosthetic mesh may increase the incidence of infective complications in these immunosuppressed
patients. Also, there is fear that one is not able to monitor the renal graft by ultrasound and perform biopsy in the
presence of a mesh. Other alternative techniques to mesh closure include subcutaneous placement and intraperitonealization
of the kidney transplant. These techniques however, are valuable when mesh closure is unfavorable or contraindicated
as in case of a potential source of infection, like a stoma. Abdominal wall fasciotomy can be adjunctive to the
various techniques of muscle closure.