Surgical complications after intestinal transplantation in infants and children—UK experience

Reconstruction of Large Abdominal Wall Defects Using Neurotized Vascular Composite Allografts

“…Forceful abdominal closure under tension is widely recognized to be detrimental, causing compartment syndrome, allograft loss, wound healing complications, and hemodynamic compromise. 7,12,13 In an effort to mitigate the complications associated with tensioned primary closure, several approaches such as pretransplantation tissue expansion, biological tissue matrices, nonvascularized rectus fascia, and vascularized rectus fascia have been proposed to decreased incisional tension. 4,7,12,14 However, each of these modalities carries risk.…”

“…7,12,13 In an effort to mitigate the complications associated with tensioned primary closure, several approaches such as pretransplantation tissue expansion, biological tissue matrices, nonvascularized rectus fascia, and vascularized rectus fascia have been proposed to decreased incisional tension. 4,7,12,14 However, each of these modalities carries risk. A review of pretransplantation tissue expansion in 46 patients undergoing multivisceral transplantation revealed a significant complication rate that prompted a shift to staged closure.…”

“…A review of pretransplantation tissue expansion in 46 patients undergoing multivisceral transplantation revealed a significant complication rate that prompted a shift to staged closure. 7 A review of immediate closure of intestinal transplantation and multivisceral transplantation using biological tissue matrices in 30 patients demonstrated significant surgical-site morbidity, with 100 percent of patients requiring reoperation. 14 Immediate abdominal closure of 16 multivisceral transplantation patients with nonvascularized rectus fascia resulted in surgical-site infections in half of the patients.…”

“…4 Furthermore, any attempt to close the abdomen under tension can result in complications, including dehiscence, evisceration, necrosis of bowel, abdominal compartment syndrome, and respiratory complications. [5][6][7] As such, up to 50 percent of multivisceral transplants are complicated by difficult-to-close and/ or open abdomens. 4 As a result of these difficulties, several modalities have been proposed to assist in closure of the abdomen at the time of surgery.…”

Pediatric small bowel transplantation

“…However, surgical complications remain common. Some groups reported reoperation rates around 60% related to thrombosis, bleeding, anastomotic dehiscence or abscesses [17][18][19].…”