Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

Abstract

Background Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes. Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted. Results A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy. Conclusion AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…This is performed in the context of small bowel or multivisceral transplantation due to the severe abdominal fibrosis and loss of abdominal domain often encountered in these patients [86,87]. The cases of AW-VCA described in the current literature are non-innervated [88]. This is a key critique of this technique as the graft musculature is non-functional, and will inevitably atrophy without re-innervation (Reed).…”

Potential options to expand the intestinal donor pool: a comprehensive review

“…Alternatively, the implementation of several techniques to expand the abdominal wall after transplantation [e.g. (non) vascularized fascia or full-thickness abdominal wall transplant] also allows the use of larger grafts [16,17 ▪ ]. Especially in case of multivisceral transplantation or chronic pseudo-obstruction, size-mismatch has safely been performed, because of the preserved abdominal domain in these patients [15].…”

Video Messaging to Increase Vascularized Composite Allograft Donation Willingness in United States Military Veterans

“…Many clinical, scientific, ethical, and regulatory advancements have been made in vascularized composite allograft (VCA) transplantation in recent years. [1][2][3][4][5][6][7][8][9][10][11][12][13] Expanding VCA transplantation depends on the public's willingness to donate VCA organs. Although VCA transplantation and donation attitudes are generally favorable, willingness to donate VCA organs lags behind that of more traditional solid organs.…”