Techniques for abdominal wall reconstruction in intestinal transplantation

Gondolesi, Gabriel; Aguirre, Nicolás

doi:10.1097/mot.0000000000000394

Cited by 14 publications

(12 citation statements)

References 21 publications

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“…Abdominal wall transplantation is still a rarely used technique given that intestinal and multivisceral transplants are uncommon; in fact, only 32 cases have been reported in the literature to date. 4,5,11 Although abdominal wall transplantation is rarely needed, successful outcomes are essential to achieve as abdominal wall complications can negatively impact outcomes of intestinal and multivisceral transplants. 2,9,13 Among the 32 cases reported in the literature (comprising four case series of multivisceral transplantation or IT using a full-thickness vascularized abdominal wall graft), the following complications were identified: thrombosis in two cases; graft versus host disease in two cases, and graft rejection in 13 cases.…”

Section: Discussionmentioning

confidence: 99%

“…2,9,13 Among the 32 cases reported in the literature (comprising four case series of multivisceral transplantation or IT using a full-thickness vascularized abdominal wall graft), the following complications were identified: thrombosis in two cases; graft versus host disease in two cases, and graft rejection in 13 cases. 11 Our full-thickness procurement technique is similar to that described by the Miami group. 6 In addition, however, we flush the graft using a low-viscosity preservation solution, performed synchronously with the flushing of the abdominal organs, and clamp the femoral arteries in order to obtain better graft perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…4 A recent review of the 32 cases of abdominal wall transplant reported in the literature showed a rate of infection of 18.7%, with incomplete skin coverage over the fascia being the main cause of infection. 11 Infections are also related to the integrity of the abdominal graft. In this regard, we believe that our novel technique can reduce the risk of infection as flushing of the graft minimizes ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Abdominal wall transplantation remains a scarcely known and rarely indicated technique, being necessary when primary fascial closure cannot be performed due to decreased abdominal domain, such as in multivisceral transplantation (MVT) or intestinal transplantation (IT), as well as, on occasion, after liver transplantation (LT). 4,5,[8][9][10][11] The most common indication for abdominal wall transplantation is for patients who require reconstruction of the abdominal wall because of the loss of the abdominal domain due to prior multiple abdominal surgeries, presence of enterocutaneous fistulas or desmoid TA B L E 1 Indications for abdominal wall transplantation and donor selection…”

Section: Introductionmentioning

confidence: 99%

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New technique for abdominal wall procurement. Initial experience

Alonso

Marcacuzco

Caso

et al. 2021

Clinical Transplantation

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

New technique for abdominal wall procurement. Initial experience

Alonso

Marcacuzco

Caso

et al. 2021

Clinical Transplantation

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“…Since this original report in 2009, 16 more cases have been reported. The Berlin group used the abdominal rectus muscle fascia in five adult cases, with no infections being reported . In their updated experience of 19 patients (nine paediatric and 10 adults) who received the abdominal rectus muscle fascia, Gondolesi's group report that, at a median follow‐up of 52.17 ± 43.16 months, none had a ventral hernia.…”

Section: Discussionmentioning

confidence: 99%

The difficult abdominal closure after paediatric intestinal transplantation: Use of abdominal rectus muscle fascia and literature review

Cassar

Cortes‐Cerisuelo

Bambridge

et al. 2019

Pediatric Transplantation

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Primary abdominal wall closure after intestinal and multivisceral transplantation may not be possible because of loss of abdominal domain and/or graft size/abdominal cavity mismatch. Traditional closure techniques for the open abdomen may not be valid in these circumstances because of severe scarring of the abdominal wall from multiple previous surgeries in this particular group of patients. We present our initial experience with the use of non‐vascularized abdominal rectus muscle fascia in two patients who underwent deceased donation and living‐related combined liver and small bowel transplantation, respectively, and who could not be closed primarily. The donor fascia was attached to the recipient fascia in both patients. In either case, there was not enough skin cover for closure, the wound was left open, and a negative pressure dressing was applied. In both cases, over a period of 6 months after placement of the non‐vascularized abdominal rectus muscle fascia, the wound contracted, granulation tissue gradually covered the wound, and healing occurred, giving an intact abdominal wall. The abdominal rectus muscle fascia from a deceased donor can be used in a definite procedure for closure of the abdominal wall either at the time of transplant or later when a suitable rectus muscle fascia graft becomes available.

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