Neilendu Kundu¹, Risal Djohan², Koji Hashimoto¹, Charles Miller¹, Bijan Eghtesad¹, John Fung¹, Cristiano Quintini¹

¹Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States; ²Plastic Surgery and Dermatology Institute, Cleveland Clinic, Cleveland, OH, United States

Introduction: Abdominal closure continues to be a major challenge in patients undergoing intestinal transplantation. Loss of abdominal domain combined with ischemia reperfusion injury, as well as graft edema, can cause graft exposure leading to catastrophic complications. Various techniques to achieve closure have been described including staged procedures, use of cadaveric and biologic fascia, and in extreme cases abdominal wall transplantation. The aim of this study was to describe our experience with the use of tissue expanders in conjunction with complex abdominal reconstruction in this patient population.

Methods: A total of 13 abdominal tissue expanders were placed in five patients and followed with computerized tomographic (CT) imaging. Dimensional analysis was subsequently performed to ascertain the increase in volume at the end of the expansion process. 

Results: One patient developed an infection necessitating removal in two of three expanders. After this, we modified our technique and achieved successful expansion in the remaining four patients without complications. The average volumetric gain per patient was 523.1 cubic centimeters (cc) – ranging from 299.5 cc to 1369.4 cc. The average expansion time was approximately three months and was well tolerated. Three of the five patients underwent small bowel transplantation and primary closure.  Two patients are currently on the waiting list.

Conclusion: In our experience, tissue expansion was safe, feasible, and effective in providing abdominal wall augmentation prior to intestinal transplantation. This tool, when combined with complex abdominal wall reconstruction, can prevent graft exposure and its devastating consequences.