Acellular Dermal Matrix Provides a Good Option for Abdominal Wall Closure Following Small Bowel Transplantation: A Case Report

E. Asham, M. E. Uknis, Cristiana Rastellini, G. Elias, Luca Cicalese

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Following small bowel transplantation (SBTx), approximating the midline abdominal fascia can be problematic in patients with severely retracted abdominal cavities. We first report the use of acellular dermal matrix (ADM) for abdominal closure following living related SBTx. A 44-year-old woman with ultra-short gut syndrome secondary to multiple bowel resections received a 160-cm segmental intestinal graft from her daughter. The graft ileocolic vessels were anastomosed end to side to the inferior vena cava and distal aorta. A terminal ileostomy was fashioned because the patient had previous panproctocolectomy. The graft perfused well, and the laparotomy was primarily closed. On postoperative day 1, the patient required surgical exploration for evacuation of hematoma. Due to graft edema in a significantly retracted abdominal cavity, a 12×7 cm fascia defect was evident. Leaving the abdomen open or using a mesh was not entertained as options due to the high risk of infections. Primary closure under tension would also jeopardize the transplant, increasing the risk of thrombosis. The fascia defect was closed using a segment of ADM. The patient did well and went home on the postoperative day 11. At 2-year follow-up she is well and on oral diet without fascia defect or incisional hernia. This is the first report of the use of ADM for abdominal closure in patients receiving a SBTx. ADM is considered safe when used in contaminated sites and can allow primary closure of difficult wounds often seen in SBTx patients.

Original languageEnglish (US)
Pages (from-to)1770-1771
Number of pages2
JournalTransplantation Proceedings
Volume38
Issue number6
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Acellular Dermis
Abdominal Wall
Transplantation
Fascia
Transplants
Abdominal Cavity
Ileostomy
Inferior Vena Cava
Nuclear Family
Hematoma
Abdomen
Laparotomy
Aorta
Edema
Thrombosis
Diet
Wounds and Injuries
Infection

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Acellular Dermal Matrix Provides a Good Option for Abdominal Wall Closure Following Small Bowel Transplantation : A Case Report. / Asham, E.; Uknis, M. E.; Rastellini, Cristiana; Elias, G.; Cicalese, Luca.

In: Transplantation Proceedings, Vol. 38, No. 6, 07.2006, p. 1770-1771.

Research output: Contribution to journalArticle

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