Abdominal Wall Closure in Recipients of Intestinal and Multivisceral Transplants

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Recipients of intestinal and multivisceral transplantation often present with difficult closure of the abdomen at time of surgery because of loss of abdominal domain from previous surgeries or edema of the graft. When primary abdominal closure is not feasible, multiple techniques can be utilized, including placement of a mesh, secondary closure, rotational flaps, and more recently, the use of the abdominal wall transplant and fascia of the rectus muscle. The abdominal wall transplant uses a vascularized composite graft based on the inferior epigastric vessels, which includes skin, subcutaneous tissue, rectus muscles, and peritoneum. It has been successfully utilized in selected cases of intestinal transplant recipients to cover large fascial defects otherwise impossible to bridge with conventional techniques. The fascia of rectus muscle utilizes the anterior and posterior leaflets of the rectus muscle retrieved from tissue donors. It is a nonvascularized graft that can be used as a biological mesh not only at time of transplant but also for closure of incisional hernias in post-transplant patients. In addition, this type of graft can be stored as fresh frozen for long-term use.