Acellular dermal matrix prevents intra-abdominal hypertension for abdominal wall closure following small bowel transplantation: A case report

Abstract

Objective To investigate the effect of acellular dermal matrix (ADM) for abdominal closure to prevent abdominal high pressure after intestinal transplantation. Method ADM was used for abdominal closure following intestinal transplantation in a 17-year-old man with ultra-short bowel syndrome. Two ADMs with 12 cm 20 cm were reconstituted intraoperatively with warm sterile normal saline. After flattened under peritoneum, the ADM was pruned and then sewn to the muscular layer of abdominal wall by interrupted transfixing suture with absorbable suture. A negative pressure drainage tube was placed over an area of native fascia in the subcutaneous space. Skin and soft tissues were closed by interrupted suture. Result The intra-abdominal pressure was not higher than 7 cmH2O 90 h post-operation. The ventilator has been withdrawn 18 h after operation. Enternal nutrition was given from postoperative day 6. He required surgical exploration for abdominal abscess on the postoperative day 19. The ADM closely adhered to the abdominal wall and no abscess in abdomen was related to ADM. Conclusion ADM can be safely used for abdominal closure and effectively prevent intra-abdominal high pressure in this intestinal transplantation. No infection or graft loss occurred in the early postoperative period. More observations are needed to study the long-term results and complications in the future. Key words: Acellular dermal matrix; Intestinal transplantation; Abdominal wall closure; Intra-abdominal hypertension