Use of Nonvascularized Abdominal Rectus Fascia After Liver, Small Bowel, and Multiorgan Transplantation: Long-Term Follow-up of a Single-Center Series

Farinelli, Pablo; Rubio, Juan S.; Padín, Juan Manuel; Rumbo, Carolina; Solar, Héctor; Ramisch, Diego; Gondolesi, Gabriel

doi:10.1016/j.transproceed.2017.05.012

Cited by 16 publications

(50 citation statements)

References 11 publications

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“…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. In this cohort, 12 out of 19 recipients required 23 reoperations.…”

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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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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“…If it becomes necessary to perform a re-laparotomy, this can be performed either by removing and re-implanting NVRF or by transecting it down the midline and closing with a polypropylene or nylon suture. Although a theoretical risk, no series has reported the development of ventral herniae [10].…”

Section: Non-vascularised Rectus Fasciamentioning

confidence: 99%

Closing the abdomen: update on the current surgical toolkit

Amin

Canovai²

2022

Current Opinion in Organ Transplantation

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Purpose of reviewAchieving abdominal wall closure after intestinal transplantation (ITx) is one of the crucial surgical challenges. This problem is present in 25–50% of all transplants due to reduction in abdominal domain, fistulae and extensive adhesions due to previous surgeries. Failure to achieve closure is an independent risk factor for mortality and graft loss. The aim of this paper is to summarize the current options to achieve this.Recent findingsSuccessful closure of the abdomen requires a tension-free repair. Primary closure of the fascia can be reinforced with synthetic or biological mesh. For more complex fascial defects bridging mesh, nonvascularised or vascularised rectus fascia can be utilised. If all components of the abdominal wall are affected, then a full-thickness abdominal wall transplantation may be necessary.SummaryA variety of successful techniques have been described by different groups to enable abdominal wall closure after ITx. Emerging developments in preoperative imaging, reconstructive surgery and immunology have expanded the surgical toolkit available. Crucial is a tailor-made approach whereby patients with expected closure issues are identified prior to surgery and the simplest technique is chosen.

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“…-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.…”

Section: Indications For Abdominal Wall Transplantationmentioning

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%

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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Use of Nonvascularized Abdominal Rectus Fascia After Liver, Small Bowel, and Multiorgan Transplantation: Long-Term Follow-up of a Single-Center Series

Cited by 16 publications

References 11 publications

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

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

Closing the abdomen: update on the current surgical toolkit

New technique for abdominal wall procurement. Initial experience

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