Functional Abdominal Wall Reconstruction Using an Innervated Abdominal Wall Vascularized Composite Tissue Allograft: A Cadaveric Study and Review of the Literature

Broyles, Justin M.; Berli, Jens U.; Tuffaha, Sami H.; Sarhane, Karim A.; Cooney, Damon S.; Eckhäuser, Frederic E.; Lee, W. P. Andrew; Brandacher, Gerald; Singh, Devinder P.; Sacks, Justin M.

doi:10.1055/s-0034-1381958

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…14 Although this study looked at only pristine donor cadavers and the raised flaps were not transplanted into recipients, it was the first study to look into the possibility of transplanting nerves as part of the abdominal wall allotransplant to preserve functionality and improve durability. 14…”

Section: Resultsmentioning

confidence: 99%

“…Being nonneurotized, the muscles in these grafts are unable to function or provide dynamic support; therefore, all patients will eventually experience extensive muscle atrophy. 13,14…”

mentioning

confidence: 99%

“…Being nonneurotized, the muscles in these grafts are unable to function or provide dynamic support; therefore, all patients will eventually experience extensive muscle atrophy. 13,14 Murine models have shown success in transplanting neurotized abdominal walls, and cadaveric studies have demonstrated that it is feasible to dissect donor abdominal nerves to coapt in the recipient to restore and maintain form and function. 13,14 Indeed, a small series of 11 patients reports that the rectus abdominis muscle can be successfully neurotized to reconstruct the quadriceps extensor mechanism.…”

mentioning

confidence: 99%

“…13,14 Murine models have shown success in transplanting neurotized abdominal walls, and cadaveric studies have demonstrated that it is feasible to dissect donor abdominal nerves to coapt in the recipient to restore and maintain form and function. 13,14 Indeed, a small series of 11 patients reports that the rectus abdominis muscle can be successfully neurotized to reconstruct the quadriceps extensor mechanism. 15 The introduction of neurotized abdominal wall allotransplantation has the potential to expand the use of abdominal wall allotransplantation to those outside of the realm of visceral organ allotransplant recipients, if the form and function of the transplant proved to be sufficient.…”

mentioning

confidence: 99%

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Twenty Years of Abdominal Wall Allotransplantation: A Systematic Review of the Short- and Long-Term Outcomes

Reed

Echternacht

Shanmugarajah

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Abdominal wall allotransplantation following intestinal and multivisceral transplant procedures has proven to be successful in achieving adequate closure in patients in whom other techniques have proven inadequate. Thus far, the focus of these abdominal wall allotransplants has been on graft and overall patient survival following surgery and the implementation of immunosuppression. The purpose of this study was to review the outcomes of abdominal wall allotransplantation reported in the literature. Methods: The PubMed database was queried, and 2595 articles were found. Search criteria used were “abdominal wall transplant” and “abdominal wall allotransplant.” Of these, eight met inclusion/exclusion criteria. Results: In the present study, eight publications were identified reporting abdominal wall allotransplants, for a total of 38 full-thickness abdominal wall allotransplantations performed worldwide. All studies reported abdominal wall allotransplantation in combination with visceral organ allotransplantation. Abdominal wall allotransplantations reported thus far have been nonneurotized. Abdominal wall allotransplantations have proven to be beneficial both in terms of abdominal wall closure and acting as a sentinel marker for rejection for underlying visceral organ allotransplantation. The success of abdominal wall allotransplants and their long-term survival has introduced the question of functionality and long-term durability. Cadaveric studies have shown that it is possible to neurotize abdominal wall allotransplants, and future direction toward neurotized abdominal wall allotransplantation requires tools to assess functional outcomes of these transplants. Conclusions: Abdominal wall allotransplantation is an important reconstructive option when abdominal wall closure is challenging and should be considered in combination with visceral organ allotransplantations. There may be potential benefit in neurotizing the abdominal wall allotransplant for functional use, and future studies should aim to include functional outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Being nonneurotized, the muscles in these grafts are unable to function or provide dynamic support; therefore, all patients will eventually experience extensive muscle atrophy. 13,14…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Twenty Years of Abdominal Wall Allotransplantation: A Systematic Review of the Short- and Long-Term Outcomes

Reed

Echternacht

Shanmugarajah

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…The usefulness and feasibility of neurotization in AWT have been debated. Although there have been no reported cases of neurotization in AW-VCA, Broyles et al 13 performed a cadaveric study to determine the feasibility of neurotization in AWT. The authors were able to identify thoracolumbar nerves during their study and determined that the nerves were of adequate length and caliber to perform coaptation.…”

Section: Considerations For Future Abdominal Wall Transplantationmentioning

confidence: 99%

Synchronous Abdominal Wall and Small-bowel Transplantation: A 1-year Follow-up

Atia

Hollins

Erdmann

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Abdominal wall–vascularized composite allotransplantation (AW-VCA) has evolved as a technically feasible but challenging option in the rare event of abdominal wall reconstruction in patients whose abdomen cannot be closed by applying conventional methods. The authors conducted the first synchronous child-to-adult recipient AW-VCA using an arteriovenous loop technique. This article presents a 1-year follow-up of the patient’s postoperative course. Frequent skin biopsies were performed in accordance with Duke Institutional Review Board protocol, with 3 episodes of rejection treated with high-dose steroids and Thymoglobulin (Genzyme Corp, Cambridge, Mass.). The patient developed an opportunistic fungal brain abscess secondary to immunosuppression, which led to temporary upper extremity weakness. Future considerations for AW-VCA include a modified surgical technique involving utilization of donor vein graft for arteriovenous loop formation. In addition, reduction in postoperative biopsy schedule and changes in immunosuppression regimen may lead to improved outcomes and prevent unnecessary high-dose immunosuppression.

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