title: Delayed dynamic abdominal wall closure following multi-visceral transplantation.
abstract: BACKGROUND
  Primary closure of the abdominal wall following intestinal transplantation or multivisceral transplantation could become a challenging problem in a significant number of patients.
  
  
  METHODS
  A 38-year-old woman with familial adenomatous polyposis (FAP) underwent a multi-visceral transplantation for short gut syndrome. She subsequently developed acute graft rejection that proved resistant to conventional treatment. She was relisted and underwent re-transplantation along with kidney transplantation. Abdominal wall closure could not be achieved because of the large size of the graft and bowel oedema. The wound was initially managed with laparostomy followed by insertion of the delayed dynamic abdominal closure (DDAC) device (Abdominal Retraction Anchor - ABRA(®) system). Continuous dynamic traction to the wound edges resulted in gradual approximation and complete closure of the abdominal wound was achieved within 3 weeks.
  
  
  CONCLUSIONS
  Successful abdominal closure after multivisceral transplantation or isolated intestinal transplantation often requires biological mesh, vascularised flaps or abdominal wall transplantation. DDAC eliminated the need for a prosthetic mesh or skin graft and provided an excellent cosmetic result. Adjustment of the dynamic traction at the bedside minimised the need for multiple returns to the operating theatre. It resulted in a well-healed linear scar without a hernia.
  
  
  CONCLUSIONS
  Dynamic traction allows delayed closure of laparotomy resulting in strong and cosmetically sound wound healing with native tissue.
authors.affiliation: Department of Surgery, Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Electronic address: satheeshiype@gmail.com.
authors.forename: Satheesh
authors.initials: S
authors.lastname: Iype
authors.affiliation: Department of Surgery, Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Electronic address: andrew.butler@addenbrookes.nhs.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Butler
authors.affiliation: Department of Surgery, Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Electronic address: Neville.jamieson@addenbrookes.nhs.uk.
authors.forename: Neville
authors.initials: N
authors.lastname: Jamieson
authors.affiliation: Department of Gastrenterology, Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Electronic address: Stephen.middleton@addenbrookes.nhs.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Department of Surgery, Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Electronic address: asif.jah@addenbrookes.nhs.uk.
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
keywords: Abdominal compartment syndrome; Abdominal domain; Delayed abdominal closure; Multivisceral transplantation