Use of the abdominal rectus fascia as a nonvascularized allograft for abdominal wall closure after liver, intestinal, and multivisceral transplantation.
BACKGROUND
Abdominal wall closure management has become an important challenge during recipient candidate selection, at the time of donor to recipient matching and during the planning of the surgical procedure for intestinal or multiorgan transplantation. Different strategies have been proposed to overcome the lack of abdominal domain: to reduce the graft size or to increase the abdominal domain. Based on the recent concept of using an acellular dermis matrix (Alloderm) and the availability of abdominal wall tissues from the same organ donor, we conceived the idea of using the fascia of the rectus muscle (FoRM) as a nonvascularized tissue allograft.


METHODS
This is a retrospective report of a series of 16 recipients of FoRM as part of a liver, intestinal, or multiorgan transplant procedure performed between October 2004 and May 2008 at three different transplant centers.


RESULTS
Of the 16 recipients of FoRM, all but one case was performed during their transplantation (four multivisceral, two modified multivisceral, three isolated intestine, and two livers). Five patients underwent a retransplant surgery (two livers, two multivisceral, and one isolated intestine). Abdominal wall infection was present in 7 of 16 cases. Nine patients are still alive. No deaths were related to wound infection. Long-term survival showed complete wound healing and only one ventral hernia.


CONCLUSIONS
The use of a nonvascularized FoRM is a novel and simple surgical option to resolve complex abdominal wall defects in liver/intestinal/multivisceral transplant recipients when it can be covered with the recipient skin.
Gondolesi
Gabriel
G
Unidad de Nutrición, Rehabilitación y Transplante Intestinal, Fundación Favaloro, Buenos Aires, Argentina. ggondolesi@ffavaloro.org
Selvaggi
Gennaro
G
Tzakis
Andreas
A
Rodríguez-Laiz
Gonzalo
G
González-Campaña
Ariel
A
Fauda
Martín
M
Angelis
Michael
M
Levi
David
D
Nishida
Seigo
S
Iyer
Kishore
K
Sauter
Bernhard
B
Podesta
Luis
L
Kato
Tomoaki
T
D000009:Abdominal Muscles / Q000033:anatomy & histology / Q000637:transplantation*; D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000379:methods*; D014781:Viscera / Q000637:transplantation*