New technique for the extraction of abdominal wall grafts
Iago Justo1, Alberto Marcacuzco1, Oscar Caso1, Alejandro Manrique1, Jorge Calvo1, Alvaro García-Sesma1, Felix Cambra1, Clara Fernández1, Carmelo Loinaz1, Carlos Jiménez1.
1HPB and Abdominal Transplant Unit, 12 de Octubre University Hospital, Madrid, Spain
Introduction: Difficulties in proper abdominal wall closure are frequent after multivisceral transplant, isolated intestinal transplant and some cases of liver transplantation, due to the loss of the abdominal content. Several methods have been published for primary closure of the abdominal wall. Examples include the use of biological meshes, separation of components, which is exceptional given the past history of multiple abdominal interventions in these patients, and finally, full thickness graft and non-vascularized fascia.
Methods: We describe a novel technique for full-thickness abdominal wall extraction, in which the abdominal wall is perfused synchronically with the rest of the abdominal organs. This technique minimizes the ischemic time and allows for a subsequent decision between using a full-thickness graft or non-vascularized fascia.
Results: We have performed six non vascularized fascia transplants in three intestinal transplant recipients, one multivisceral recipient and two liver transplant recipients. The size of the abdominal wall defects that we have covered with these grafts vary between 17x7 cm to 25x20 cm. Only one of the patients developed an enterocutaneous fistula that required multiple takebacks to the operating room and required a complete removal of the fascia graft. This patient, along with two more, ultimately died from sepsis. We were able to properly close all of the donors. On microscopy, all the fascial grafts showed less areas of necrosis and picnosis, as compared to those performed with the classic technique.
Conclusions: Our extraction technique allows for donation of a graft that allows us to close large defects in the recipients with non-vascularized fascia. Further studies are needed to prove the benefits of full-thickness grafts.
right-click to download