title: Role of tissue expanders in patients with loss of abdominal domain awaiting intestinal transplantation.
abstract: Abdominal closure is a complex surgical problem in intestinal transplant recipients with loss of abdominal domain, as graft exposure results in profound morbidity. Although intraoperative coverage techniques have been described, this is the first report of preoperative abdominal wall augmentation using tissue expanders in patients awaiting intestinal transplantation. We report on five patients who received a total of twelve tissue expanders as a means to increase abdominal surface area. Each patient had a compromised abdominal wall (multiple prior operations, enterocutaneous fistulae, subcutaneous abscesses, stomas) with loss of domain and was identified as high risk for an open abdomen post-transplant. Cross-sectional imaging and dimensional analysis were performed to quantify the effect of the expanders on total abdominal and intraperitoneal cavity volumes. The overall mean increase in total abdominal volume was 958 cm(3) with a mean expander volume of 896.5 cc. Two expanders were removed in the first patient due to infection, but after protocol modification, there were no further infections. Three patients eventually underwent small bowel transplantation with complete graft coverage. In our preliminary experience, abdominal tissue expander placement is a safe, feasible, and well-tolerated method to increase subcutaneous domain and facilitate graft coverage in patients undergoing intestinal transplantation.
authors.affiliation: Department of General Surgery, Transplantation Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Watson
authors.forename: Neilendu
authors.initials: N
authors.lastname: Kundu
authors.forename: Christopher
authors.initials: C
authors.lastname: Coppa
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago Uso
authors.forename: Namita
authors.initials: N
authors.lastname: Gandhi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nassar
authors.forename: Kareem
authors.initials: K
authors.lastname: Abu-Elmagd
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D005260:Female; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D015625:Tissue Expansion Devices; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin
keywords: intestinal transplantation; loss of domain; tissue expanders