David Levi, Gennaro Selvaggi, Seigo Nishida, Akin Tekin, Phillip Ruiz, Andreas Tzakis

Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States

Background: Abdominal closure during intestinal transplantation is sometimes difficult due to prior to damage to the recipient's abdominal wall.  This report describes our experience using deceased donor rectus abdominus fascia as a nonvascularized biological material to facilitate closure in recipients with massive abdominal wall defects.

Methods: The bilateral rectus abdominus fascia was obtained as part of the multiorgan procurement procedure.  It was stored in cold preservation solution and prepared at the back-table by removing the rectus muscle and subcutaneous tissue; the peritoneum was left attached.  The umbilical defect was closed and the anterior and posterior rectus fascia were left in continuity as a bilayer.  At the time of recipient abdominal closure, extensive skin flaps were raised and relaxing incisions in the native fascia were made to minimize the residual fascial defect.  The prepared donor fascia was sewn to the edges of the native fascia to accomplish closure.  The skin and subcutaneous tissue flaps were approximated over the fascia to complete the closure.   

Results: Between October 2004 and February 2011, eighteen patients received twenty segments of donor fascia to facilitate closure after intestinal transplantation. The series included 9 adults and 9 children; 4 males and 14 females.  The age range was 5 months to 52 years.  The type of intestinal grafts included isolated small bowel (n=3), modified multivisceral (n=3), and multivisceral (n=12).  4 cases were retransplants and in 2 cases two pieces of fascia were used.  In 13 cases, the abdomen was closed with donor fascia several days after the intestinal transplant procedure.  Infection of the abdominal wall requiring removal of the donor fascia was required in 2 cases.  No incisional hernias have been observed. 

Conclusion: The use of donor fascia as a nonvascularized, biological mesh can facilitate closure of the abdominal wall in selected patients undergoing intestinal transplantation.