title: Use of vascularized posterior rectus sheath allograft in pediatric multivisceral transplantation--report of two cases.
abstract: Restoring abdominal wall cover and contour in children undergoing bowel and multivisceral transplantation is often challenging due to discrepancy in size between donor and recipient, poor musculature related to birth defects and loss of abdominal wall integrity from multiple surgeries. A recent innovation is the use of vascularized posterior rectus sheath to enable closure of abdomen. We describe the application of this technique in two pediatric multivisceral transplant recipients--one to buttress a lax abdominal wall in a 22-month-old child with megacystis microcolon intestinal hypoperistalsis syndrome and another to accommodate transplanted viscera in a 10-month child with short bowel secondary to gastoschisis and loss of domain. This is the first successful report of this procedure with long-term survival. The procedure has potential application to facilitate difficult abdominal closure in both adults and pediatric liver and multivisceral transplantation.
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA. kadiyala.ravindra@duke.edu
authors.forename: K V
authors.initials: KV
authors.lastname: Ravindra
authors.forename: A E
authors.initials: AE
authors.lastname: Martin
authors.forename: D S
authors.initials: DS
authors.lastname: Vikraman
authors.forename: T V
authors.initials: TV
authors.lastname: Brennan
authors.forename: B H
authors.initials: BH
authors.lastname: Collins
authors.forename: A S
authors.initials: AS
authors.lastname: Rege
authors.forename: S T
authors.initials: ST
authors.lastname: Hollenbeck
authors.forename: L
authors.initials: L
authors.lastname: Chinappa-Nagappa
authors.forename: K
authors.initials: K
authors.lastname: Eager
authors.forename: D
authors.initials: D
authors.lastname: Cousino
authors.forename: D L
authors.initials: DL
authors.lastname: Sudan
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D003106:Colon / Q000002:abnormalities / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007418:Intestinal Pseudo-Obstruction / Q000601:surgery*; D008297:Male; D016377:Organ Transplantation; D014184:Transplantation, Homologous; D001743:Urinary Bladder / Q000002:abnormalities / Q000601:surgery