New technique for abdominal wall procurement. Initial experience

Abstract

Difficulty in obtaining adequate abdominal wall closure due to loss of the abdominal domain is a frequent complication of multivisceral, isolated intestinal transplantation and in some cases of liver transplantation. Various methods for primary closure have been proposed, including the use of synthetic and biological meshes, as well as full-thickness abdominal wall and non-vascularized rectus fascia grafts. We describe a novel technique for abdominal wall procurement in which the graft is perfused synchronously with the abdominal organs and can be transplanted as a full-thickness wall or as a non-vascularized rectus fascia graft. We performed six transplants of nonvascularized rectus fascia in three intestinal transplants, one multivisceral transplant, and two liver transplants. The size of the covered abdominal wall defects ranged from 17 cm × 7 cm to 25 cm × 20 cm. Only one patient developed graft infection secondary to enterocutaneous fistula requiring surgical correction and removal of the fascia graft.This patient, as well as two other patients, died due to sepsis. Our procurement technique allows removal of the rectus fascia graft to cover the abdominal wall defect, providing a feasible solution for treatment of abdominal wall defects in recipients after abdominal organ transplantation.

Innovative surgical techniques in the intestine and multivisceral transplant

“…AWT involves grafting partial or full-thickness abdominal wall tissue, with the same donor used for intestinal transplant. Immunological matching is not a concern, and AWT does not necessitate www.co-transplantation.com additional immunosuppression [37,[38][39][40][41][42][43]. Patients who undergo the discussed transplants usually have long surgical histories or diseases that severely damage the abdominal walls, severely complicating the possibility of primary closure [36].…”

“…Generally, the most commonly used techniques are meshes, both absorbable and nonabsorbable, acellular dermal matrix, bioengineered skin equivalents, and rectus fascia as a nonvascularized allograft to replace the fascia, each with its indications and limitations [47,[50][51][52]. For more complex cases, such as when all components of the abdominal wall are affected, an increasing option is the AWT, in which partial or full-thickness abdominal wall grafts are used to close the cavity [37,[38][39][40][41][42].…”