title: Technical advances for abdominal wall closure after intestinal and multivisceral transplantation.
abstract: OBJECTIVE
  Abdominal wall closure after intestinal transplantation (ITX) or multivisceral transplantation (MVTX) is challenging because of the loss of abdominal domain and wall elasticity as a result of previous operations and donor-to-recipient weight and height mismatch.
  
  
  RESULTS
  We report on abdominal wall closure management in 30 ITX and MVTX recipients. In 60% of patients (n = 18), a primary abdominal closure (PAC) was achieved, in 40% (n = 12) a staged closure (SAC) was necessary. Patients with PAC had undergone less pretransplant operations and required less posttransplant relaparotomies. They were mainly ITX recipients or more abdominal domain because of a longer intestinal remnant. A literature review revealed different strategies to overcome a failed primary closure. They focus on graft reduction or an enlargement of the abdominal domain. The latter includes temporary coverage with prosthetic materials for SAC. Definite abdominal closure is achieved by skin only closure, or by using acellular dermal matrix, rotational flaps, rectus muscle fascia or abdominal wall grafts.
  
  
  CONCLUSIONS
  Abdominal wall reconstruction after ITX/MVTX is commonly demanded and can be conducted by different strategies. The technique should be easy to use in a timely manner and should prevent abdominal infections, intestinal fistulation, incisional hernias, and wound dehiscence.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité-Universitatsmedizin Berlin, Berlin, Germany.
authors.forename: Undine A
authors.initials: UA
authors.lastname: Gerlach
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D062088:Acellular Dermis; D000328:Adult; D002648:Child; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016377:Organ Transplantation / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh