Document Detail

Expanding the envelope: the posterior rectus sheath-liver vascular composite allotransplant.
MedLine Citation:
PMID:  23358016     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Primary abdominal wall reconstruction after liver transplantation presents a challenge in patients with size mismatch, multivisceral transplants, and prior recipient abdominal surgery. The authors report their experience with a novel technique for abdominal wall reconstruction with a new vascular composite allotransplant.
METHODS: Five posterior rectus sheath-liver composite vascular allotransplants were procured by a multidisciplinary team and transplanted into four patients over the course of 2 years. Liver transplantation was performed in the standard manner, and the posterior rectus sheath was inset as an inlay flap.
RESULTS: Abdominal wall integrity was reestablished with vascularized fascia in all five cases. In two cases, the fascia was closed immediately at the time of initial transplantation. In three cases, the abdomen was left open for a planned second look and closed definitively when the liver appeared satisfactory. In one patient, hepatic artery thrombosis was detected 11 days after transplantation, requiring a second posterior rectus sheath-liver transplant. Skin closure was performed for all transplants in either an immediate or a delayed fashion. Reoperation requiring elevation of the posterior rectus sheath flap for a suprahepatic vena cava stenosis was performed in one patient.
CONCLUSIONS: Closure of the abdominal cavity is critical to the success of liver transplantation for organ survival and overall patient morbidity and mortality. The authors describe their institutional experience with a novel method of concurrent abdominal wall reconstruction and liver transplantation using the posterior rectus sheath-liver vascular composite allotransplant in situations of size mismatch, multivisceral transplants, and compromised abdominal wall of the recipient.
Justine C Lee; Oyedolamu K Olaitan; Reynold Lopez-Soler; John F Renz; J Michael Millis; Lawrence J Gottlieb
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  2013-04-01     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  209e-218e     Citation Subset:  AIM; IM    
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MeSH Terms
Abdominal Wall / surgery*
Child, Preschool
Liver Transplantation / methods*
Reconstructive Surgical Procedures / methods*
Rectus Abdominis / blood supply*,  transplantation*
Retrospective Studies
Surgical Flaps / blood supply*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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