Abdominal wall closure after intestinal transplantation

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.