Open AccessRole of tissue expanders in patients with loss of abdominal domain awaiting intestinal transplantation
Author(s) -
Watson Melissa J.,
Kundu Neilendu,
Coppa Christopher,
Djohan Risal,
Hashimoto Koji,
Eghtesad Bijan,
Fujiki Masato,
Diago Uso Teresa,
Gandhi Namita,
Nassar Ahmed,
AbuElmagd Kareem,
Quintini Cristiano
Publication year - 2013
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12187
Subject(s) - medicine , tissue expander , surgery , abdomen , transplantation , abdominal cavity , abdominal wall , subcutaneous tissue , cancer , breast reconstruction , breast cancer
Summary 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.