Abdominal Wall Transplantation and Technique
Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies or enterocutaneous fistulae.
These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications.
Abdominal wall transplantation was proposed for closure of patients undergoing both small bowel and multivisceral transplantation.
We present our experience in abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to re-vascularize the composite tissue allograft anastomosing the deep inferior epigastric vessels of the graft to those of the recipient.
This technique allows to preserve donor’s vascular pedicle that can be used as grafts for vascular procedures.
KeywordsAbdominal wall defect Abdominal wall reconstruction Reconstructive surgery Microsurgery Multivisceral transplantation
- 1.Zanfi C, Cescon M, Lauro A, Dazzi A, Ercolani G, Grazi GL, Del Gaudio M, Ravaioli M, Cucchetti A, La Barba G, Zanello M, Cipriani R, Pinna AD. Incidence and management of abdominal closure-related complications in adult intestinal transplantation. Transplantation. 2008;85:1607–9.CrossRefPubMedGoogle Scholar
- 2.Berli JU, Broyles JM, Lough D, Shridharani SM, Rochlin D, Cooney DS, Lee WP, Brandacher G, Sacks JM. Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall. Clin Transplant. 2013;27(6):781–9. doi: 10.1111/ctr.12243. Epub 2013 Sep 16.CrossRefPubMedGoogle Scholar
- 4.Oikawa K, Ohkohchi N, Kato H, Orii T, Shimaoka S, Kawagishi N, Asakura T, Takayama J, Satomi S. Graft weight/recipient body weight ratio (G/R ratio) in living-related liver transplantation for pediatric patients: abdominal wall closure in cases with a large G/R ratio. Transplant Proc. 1998;30(7):3209–10.CrossRefPubMedGoogle Scholar
- 11.Di Benedetto F, Lauro A, Masetti M, Cautero N, De Ruvo N, Quintini C, Diago Uso’ T, Romano A, Dazzi A, Ramacciato G, Cipriani R, Ercolani G, Grazi GL, Gerunda GE, Pinna AD. Use of prosthetic mesh in difficult abdominal wall closure after small bowel transplantation in adults. Transplant Proc. 2005;37(5):2272–4.CrossRefPubMedGoogle Scholar
- 17.Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg. 2003;19:225e33.Google Scholar