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Muylle E, Maes A, De Hertogh G, Van De Winkel N, Kerckhofs G, Dubois A, Vandecaveye V, Thorrez L, Hennion I, Emonds MP, Pans S, Deferm NP, Monbaliu D, Canovai E, Vanuytsel T, Pirenne J, Ceulemans LJ. Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation. Transplant Direct 2024; 10:e1624. [PMID: 38757048 PMCID: PMC11098214 DOI: 10.1097/txd.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 05/18/2024] Open
Abstract
Background Failure to close the abdominal wall after intestinal transplantation (ITx) or multivisceral Tx remains a surgical challenge. An attractive method is the use of nonvascularized rectus fascia (NVRF) in which both layers of the donor abdominal rectus fascia are used as an inlay patch without vascular anastomosis. How this graft integrates over time remains unknown. The study aims to provide a multilevel analysis of the neovascularization and integration process of the NVRF. Methods Three NVRF-Tx were performed after ITx. Clinical, radiological, histological, and immunological data were analyzed to get insights into the neovascularization and integration process of the NVRF. Moreover, cryogenic contrast-enhanced microfocus computed tomography (microCT) analysis was used for detailed reconstruction of the vasculature in and around the NVRF (3-dimensional histology). Results Two men (31- and 51-y-old) and 1 woman (49-y-old) underwent 2 multivisceral Tx and 1 combined liver-ITx, respectively. A CT scan showed contrast enhancement around the fascia graft at 5 days post-Tx. At 6 weeks, newly formed blood vessels were visualized around the graft with Doppler ultrasound. Biopsies at 2 weeks post-Tx revealed inflammation around the NVRF and early fibrosis. At 6 months, classical 2-dimensional histological analysis of a biopsy confirmed integration of the fascia graft with strong fibrotic reaction without signs of rejection. A cryogenic contrast-enhanced microCT scan of the same biopsy revealed the presence of microvasculature, enveloping and penetrating the donor fascia. Conclusions We showed clinical, histological, and microCT evidence of the neovascularization and integration process of the NVRF after Tx.
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Affiliation(s)
- Ewout Muylle
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Arne Maes
- Department of Materials Engineering, KU Leuven, Leuven, Belgium
- Biomechanics Lab, Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Pole of Morphology, Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium
| | - Gert De Hertogh
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Unit of Translational Cell- and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Nele Van De Winkel
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Greet Kerckhofs
- Department of Materials Engineering, KU Leuven, Leuven, Belgium
- Biomechanics Lab, Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Pole of Morphology, Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium
- Prometheus Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
| | - Antoine Dubois
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Translational MRI Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lieven Thorrez
- Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK campus Kortrijk, Kortrijk, Belgium
| | - Ina Hennion
- Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK campus Kortrijk, Kortrijk, Belgium
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Steven Pans
- Department of Abdominal Surgery, Sint-Franciscusziekenhuis, Heusden-Zolder, Belgium
| | - Nathalie P. Deferm
- Department of Abdominal Surgery, Sint-Franciscusziekenhuis, Heusden-Zolder, Belgium
| | - Diethard Monbaliu
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Emilio Canovai
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Muylle E, Van De Winkel N, Hennion I, Dubois A, Thorrez L, Deferm NP, Pirenne J, Ceulemans LJ. Abdominal Wall Closure in Intestinal and Multivisceral Transplantation: A State-Of-The-Art Review of Vascularized Abdominal Wall and Nonvascularized Rectus Fascia Transplantation. Gastroenterol Clin North Am 2024; 53:265-279. [PMID: 38719377 DOI: 10.1016/j.gtc.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Failure to close the abdomen after intestinal or multivisceral transplantation (Tx) remains a frequently occurring problem. Two attractive reconstruction methods, especially in large abdominal wall defects, are full-thickness abdominal wall vascularized composite allograft (AW-VCA) and nonvascularized rectus fascia (NVRF) Tx. This review compares surgical technique, immunology, integration, clinical experience, and indications of both techniques. In AW-VCA Tx, vascular anastomosis is required and the graft undergoes hypotrophy post-Tx. Furthermore, it has immunologic benefits and good clinical outcome. NVRF Tx is an easy technique without the need for vascular anastomosis. Moreover, a rapid integration and neovascularization occurs with excellent clinical outcome.
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Affiliation(s)
- Ewout Muylle
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Nele Van De Winkel
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, UZ Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Ina Hennion
- Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK Campus Kortrijk, Etienne Sabbelaan 53, bus 7711, 8500 Kortrijk, Belgium
| | - Antoine Dubois
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, UZ Herestraat 49, bus 708, 3000 Leuven, Belgium
| | - Lieven Thorrez
- Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK Campus Kortrijk, Etienne Sabbelaan 53, bus 7711, 8500 Kortrijk, Belgium
| | - Nathalie P Deferm
- Department of General and Abdominal Surgery, Sint-Franciscushospital, Pastoor Paquaylaan 129, 3550 Heusden-Zolder, Belgium
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, UZ Herestraat 49, bus 708, 3000 Leuven, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Herestraat 49, bus 7003, 3000 Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
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Ceulemans LJ, Dubois A, Clarysse M, Canovai E, Venick R, Mazariegos G, Vanuytsel T, Hibi T, Avitzur Y, Hind J, Horslen S, Gondolesi G, Benedetti E, Gruessner R, Pirenne J. Outcome After Intestinal Transplantation From Living Versus Deceased Donors: A Propensity-matched Cohort Analysis of the International Intestinal Transplant Registry. Ann Surg 2023; 278:807-814. [PMID: 37497671 PMCID: PMC10549910 DOI: 10.1097/sla.0000000000006045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short-term and long-term outcomes to a propensity-matched cohort of deceased donors. BACKGROUND ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success, but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote center's collaborations. METHODS Based on the ITR, 4156 ITx were performed between January 1987 and April 2019, of which 76 (1.8%) were LD, including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/sex, weight, region, IF-cause, retransplant, pretransplant status, ABO compatibility, immunosuppression, and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. RESULTS Most LDs were performed in North America (61%), followed by Asia (29%). The mean recipient age was: 22 years; body mass index: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. Fifty-two percent of patients were at home at the time of transplant. One-/5-year patient survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively ( P =0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively ( P =0.956). Acute rejection was diagnosed in 47% of LD versus 51% of DD ( P =0.723). CONCLUSION Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.
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Affiliation(s)
- Laurens J. Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Antoine Dubois
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels, Belgium
| | - Mathias Clarysse
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Emilio Canovai
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Robert Venick
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Mattel Children’s Hospital at UCLA Medical Center, Los Angeles, CA
| | - George Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yaron Avitzur
- Department Gastroenterology, Hepatology, and Nutrition, SickKids Hospital, Toronto, Canada
| | - Jonathan Hind
- Department of Paediatric Liver, Gastrointestinal and Nutrition Centre, King’s College Hospital, London
| | - Simon Horslen
- Department of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Gabriel Gondolesi
- Department of General Surgery, Nutritional Support Unit, Liver, Pancreas, and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Enrico Benedetti
- Department of Surgery, University of Illinois Hospital, Chicago, IL
| | - Rainer Gruessner
- Department of Surgery, SUNY Downstate Health Sciences University, New York City, NY
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Clarysse M, Dubois A, Vanuytsel T, Pirenne J, Ceulemans LJ. Potential options to expand the intestinal donor pool: a comprehensive review. Curr Opin Organ Transplant 2022; 27:106-111. [PMID: 35191400 DOI: 10.1097/mot.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intestinal donation is currently restricted to 'perfect' donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated. RECENT FINDINGS Increasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient. SUMMARY Several potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.
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Affiliation(s)
- Mathias Clarysse
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
| | - Antoine Dubois
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Gastroenterology and Hepatology, University Hospitals Leuven & Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Jacques Pirenne
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Thoracic Surgery, University Hospitals Leuven & Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Janssen Y, Van De Winkel N, Pirenne J, Ceulemans LJ, Miserez M. Allotransplantation of donor rectus fascia for abdominal wall closure in transplant patients: A systematic review. Transplant Rev (Orlando) 2021; 35:100634. [PMID: 34147948 DOI: 10.1016/j.trre.2021.100634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abdominal wall closure after intestinal, multivisceral or liver transplantation can be a major challenge. Different surgical techniques have been described to close complex abdominal wall defects, but results remain variable. Two promising transplant techniques have been developed using either non-vascularized or vascularized donor rectus fascia. This systematic review aimed to evaluate the feasibility, safety, and effectiveness of the two techniques. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Human studies published between January 2000 and April 2020 were included. Methodological quality appraisal was done using an adapted 10-item standardized checklist. RESULTS The search resulted in 9 articles including 74 patients. Both techniques proved to be feasible and had similar results. After non-vascularized rectus fascia allotransplantation, there was a slightly higher rate of surgical site infections in the earlier reports. Overall, there were few complications, no fascial graft related rejections or deaths. The included articles scored low on quality appraisal, mostly due to the small number of cases and scarcely reported outcome parameters. CONCLUSIONS This systematic literature review reports two emerging new techniques for complex abdominal wall closure in transplant patients, with promising results. Standardized data collection in a prospective manner could give us more detailed information about short- and long-term outcomes. Preclinical animal studies are necessary for a thorough investigation of the mechanisms of graft integration, the risk of hernia development and the alloimmune response against the graft.
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Affiliation(s)
- Yveline Janssen
- Department of Abdominal Surgery, University Hospitals Leuven, Belgium
| | | | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT), Department of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, KU, Leuven, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), Department of Thoracic Surgery, Department of Chronic Diseases and Metabolism, research consortium BREATHE, University Hospitals Leuven, KU, Leuven, Belgium
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Belgium
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Wooten KE, Ozturk CN, Ozturk C, Laub P, Aronoff N, Gurunluoglu R. Role of tissue expansion in abdominal wall reconstruction: A systematic evidence-based review. J Plast Reconstr Aesthet Surg 2017; 70:741-751. [PMID: 28356202 DOI: 10.1016/j.bjps.2017.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/23/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tissue expanders (TEs) can be used to assist primary closure of complicated hernias and large abdominal wall defects. However, there is no consensus regarding the optimal technique, use, or associated risk of TE in abdominal wall reconstruction. METHODS A systematic search of PubMed and Embase databases was conducted to identify articles reporting abdominal wall reconstruction with TE techniques. English articles published between 1980 and 2016 were included on the basis of the following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of postoperative complications, hernia recurrence, and patient-based clinical data. RESULTS Fourteen studies containing 103 patients (85 adults and 18 children) were identified for analysis. Most patients presented with a skin-grafted ventral hernia (n = 86). The etiology of the hernia was from trauma or prior abdominal surgery. The remaining patients had TE placed before organ transplantation (n = 12) or for congenital abdominal wall defects (n = 5). The location for expander placement was subcutaneous (n = 74), between the internal and external obliques (n = 26), posterior to the rectus sheath (n = 2), and intra-peritoneal (n = 1). Postoperative infections and implant-related problems were the most commonly reported complications after Stage I. The most common complication after Stage II was recurrent hernia, which was observed in 12 patients (11.7%). Five patients with TE died. Complications and mortality were more prevalent in children, immunosuppressed patients, and those with chronic illnesses. CONCLUSIONS Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and risk profile.
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Affiliation(s)
- Kimberly E Wooten
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Cemile Nurdan Ozturk
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA.
| | - Can Ozturk
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Peter Laub
- State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Main Street, Buffalo, NY, USA
| | - Nell Aronoff
- University Libraries, State University of New York at Buffalo, Main Street, Buffalo, NY, USA
| | - Raffi Gurunluoglu
- Department of Plastic Surgery, Cleveland Clinic, Euclid Ave, Cleveland, OH, USA
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