New technique for abdominal wall retrieval: Our initial outcomes with the new technique in non-vascularized fascia
Iago Justo Alonso1, Alberto Marcacuzco1, Oscar Caso1, Isabel Lechuga1, Konstantine Shirai1, Jorge Calvo1, Alejandro Manrique1, Alvaro García-Sesma1, Carmelo Loinaz1, Carlos Jimenez-Romero1.
1Abdominal Transplant Unit, "12 de Octubre" U. H., Madrid, Spain
Introduction: Abdominal wall transplantation is a rarely used surgical technique indicated in the context of intestinal and multivisceral transplantation or in liver transplant candidates with abdominal wall problems. The two techniques described so far include the extraction of only non-vascularized fascia proposed by Favaloro –which minimizes the aesthetic damage to the donor’s body– and the full-thickness abdominal wall extraction technique proposed by Miami, with graft bank perfusion. Both techniques have less than 35% complication rates.
Methods: Since March 2018, we have performed six transplants of non-vascularized fascia with the following technique: The donor is opened by means of a cutaneous “home” flap, followed by the identification of the inferior epigastric vessels. Before perfusion of the abdominal viscera to be extracted, both common iliac arteries are cannulated up to the level of the external iliac artery, bypassing the internal iliac artery, with ligation of the external iliac artery distal to the exit of the inferior epigastric artery. No venous cannulation is performed. Synchronously with the grafts, perfusion of 1 liter of Celsior is performed for each iliac and the wall flap is covered with cold compresses. After graft removal and depending on the local conditions of the recipient, a full-thickness transplant or non-vascularized fascia transplant is decided.
Results: 6 non-vascularized fascia transplants have been performed between 14-63 years-old: 3 in intestinal transplantation, 1 in multivisceral and 2 in liver, resulting in the loss of a single wall transplant due to persistent enterocutaneous fistula. In the remaining 5 cases, the graft was maintained until the present time or loss of follow-up; a period between 3-21 months. The covered defects ranged from 17x7 cm to 25x20 cm. The main indication was the impossibility of primary closure in 4 cases, use of full graft instead of reduced in one case, and abdominal wall closure after compartment syndrome in the last one. The transplants were performed synchronously to the abdominal organ except in a case that required a second donor.
Conclusions: Our wall transplant technique is associated with a lower complication rate after wall transplantation, being a valid alternative to conventional techniques.
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