Advances in peripheral nerve regeneration as it relates to VCA

Abstract

Vascularized composite allotransplant (VCA) offers functional, social, and quality of life improvements for patients who have exhausted traditional reconstructive options. Unlike solid organ transplant, VCA success is not only based upon the quality of perfusion and level of immunosuppression, but also on the success of nerve regeneration within the transplanted part. This paper will summarize the present state of peripheral nerve regeneration in the context of VCA and will explore the latest research advances that will affect the future of the field. These advances offer promising future strategies to improve patient outcomes in VCA.

Fundamentals and Current Strategies for Peripheral Nerve Repair and Regeneration

“…For allografts, the tissue is harvested from another donor, which can increase the risk of disease transmission and immunological response. However, related to allografts, a recent and promising alternative for patients who have exhausted all reconstructive methods is the vascularized composite tissue allotransplantation (VCA) [50]. Furthermore, tacrolimus, one of the immunosuppressant drugs that will accompany the patients for a life-time when subjected to this procedure, has shown to have positive effects in PNR [51].…”

Development of a Porcine VCA Model Using an External Iliac Vessel-Based Vertical Rectus Abdominus Myocutaneous Flap

“…Nonetheless, nerve regeneration would enhance the preclinical relevance of this model, as it is an essential component of the functional success of VCA grafts, enabling both movement and sensation within the transplanted tissue. 29 This VCA model can also be employed in studies investigating novel devices for continuous microvascular blood flow monitoring in free flaps. 30 Due to the inclusion of half of the inferior portion of the rectus muscle, our VRAM flap serves as an ideal pedicle for the placement of intramuscular microvascular blood flow sensing devices.…”