TY - JOUR
T1 - Acellular Dermal Matrix Provides a Good Option for Abdominal Wall Closure Following Small Bowel Transplantation
T2 - A Case Report
AU - Asham, E.
AU - Uknis, M. E.
AU - Rastellini, C.
AU - Elias, G.
AU - Cicalese, L.
PY - 2006/7
Y1 - 2006/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=33746908143&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33746908143&partnerID=8YFLogxK
U2 - 10.1016/j.transproceed.2006.05.056
DO - 10.1016/j.transproceed.2006.05.056
M3 - Article
C2 - 16908277
AN - SCOPUS:33746908143
SN - 0041-1345
VL - 38
SP - 1770
EP - 1771
JO - Transplantation proceedings
JF - Transplantation proceedings
IS - 6
ER -