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

Abstract

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.

Allotransplantation of donor rectus fascia for abdominal wall closure in transplant patients: A systematic review

“…The search resulted in a total of 59 abstracts, including 2 additional abstracts found in the second search [2,10]. Another 4 abstracts were identified through other sources [8,14,19,20], namely congress proceedings and reference scanning.…”

“…The final 9 full-text articles included 6 case series [1,3-5,14,15] and 3 case reports [2,10,24]. All of them were based on a retrospective study design, although 1 mentioned the use of prospectively collected data [3].…”

“…In case of a VRF, 7 were performed with a LTx and 4 with a MvTx. Third party (from a different donor) NVRF was used in 16 cases [2][3][4]10,14]. For NVRF, apart from the first study where 7 cases of solely anterior fascia were reported [4], most cases were performed with a bilayer sheath for the NVRF including the peritoneal layer [2][3][4]14].…”

“…Primary closure of the abdominal wall after intestinal (ITx), liver (LTx) or multivisceral (MVTx) transplantation can be difficult to achieve due to several factors. Most of these patients have a history of multiple abdominal surgeries, ostomy, fistula(e), wound infections and may have suffered from short bowel syndrome [1][2][3][4][5][6]. This leads to the presence of a hostile and contracted abdominal wall at the time of their transplantation with subsequent loss of abdominal domain.…”

New technique for abdominal wall procurement. Initial experience

“…-Signed consent form from donor and recipient families tumors requiring abdominal wall resection, ischemia-reperfusion graft edema associated with compartment syndrome, and vascular complications leading to increased intra-abdominal pressure. 4,[8][9][10]12 It has been reported that 20-50% of patients who undergo IT will need an alternative technique to conventional primary closure of the abdominal wall. 6,13 However, these patients are generally in poor health, and, therefore, reconstructive surgery or the use of abdominal flaps is not recommended.…”