Acellular Dermal Matrix Provides a Good Option for Abdominal Wall Closure Following Small Bowel Transplantation: A Case Report
Autor: | Marc E. Uknis, Georg Elias, Luca Cicalese, E. Asham, Cristiana Rastellini |
---|---|
Rok vydání: | 2006 |
Předmět: |
Adult
Short Bowel Syndrome medicine.medical_specialty Incisional hernia medicine.medical_treatment Abdominal fascia Inferior vena cava Abdominal wall Ileum Laparotomy Intestine Small medicine Humans Colectomy Transplantation business.industry Anastomosis Surgical Rectum Fascia medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Adenomatous Polyposis Coli medicine.vein Abdomen Female Parenteral Nutrition Total business Follow-Up Studies |
Zdroj: | Transplantation Proceedings. 38:1770-1771 |
ISSN: | 0041-1345 |
Popis: | 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 12x7 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. |
Databáze: | OpenAIRE |
Externí odkaz: |