gms | German Medical Science

Introduction: A major technical problem of intestinal allograft transplantation is the inadequate size of the abdominal cavity at the time of transplantation.

Materials and methods: Between 2005 and 2008, 2 children received and intestinal allograft at our institution:

Results: The first patient, a 3 year old boy was referred plastic surgery with an open abdomen after intestinal alllografting. A topic negative pressure treatment was reapplied to seal the abdominal cavity and to enhance the growth of granulation tissue. The wound was left for active secondary wound healing, and the wound surface was significantly diminished over one year. However a residual defect of 2x3 cm could not be closed. Therefore a skin grafting was done with success.

The second patient, a 7 year old girl was presented to plastic surgery prior to intestinal allotransplantation. It was decided to increase the surface of the abdominal wall skin with tissue expanders. Three osmotic (self expanding) tissue expanders were placed subcutaneously, two (440 and 660 cc) on the right side, and one (440 cc) on the left side. After intestinal allografting the abdominal skin could be completely closed primarily.

Conclusion: Complete wound closure is preferable in patients with systemic immunosupression. Therefore the reconstruction of an adequate abdominal cavity volume should be achieved prior to transplantation. Tissue expansion is a valuable technique. The use of self expanding expanders has the advantage to avoid frequent visits for filling up the expander.