Successful surgical closure of the abdominal wall after either combined or
isolated intestinal transplantation may present a challenging dilemma for t
he plastic and reconstructive surgeon because of the following factors: res
tricted volume of the recipient abdominal cavity; donor-recipient size disc
repancies as expressed by the donor to recipient weight ratio; and signific
ant intraoperative edema. The purpose of this investigation is to present c
linical experience with 51 consecutive patients who underwent a total of 57
sequential intestinal transplantations at the University of Miami-Jackson
Memorial Hospital. A retrospective chart review of 36 pediatric (63 percent
) and 21 adult (37 percent) transplantations was performed. Age of the pedi
atric population ranged from 1 month to 13 years (mean, 2.4 years) and of t
he adult population from 22 to 55 years (mean, 33.5 years). Several diagnos
tic classifications necessitated organ transplantation. Because of insuffic
ient donor graft size for the recipient abdominal cavity in 19 transplantat
ions (33 percent),several technical modifications were used to achieve anat
omic and functional abdominal wall closure in all patients. In summary, the
plastic and reconstructive surgeon should have a significant role in the c
omprehensive: planning and management of abdominal wall closure in this cha
llenging group, of patients.