Functional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft: a cadaveric study and review of the literature

Justin M. Broyles, Jens Berli, Sami Tuffaha, Karim A. Sarhane, Damon Cooney, Frederic Eckhauser, W P Andrew Lee, Gerald Brandacher, Devinder P. Singh, Justin Michael Sacks

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications.

METHODS: Three fresh cadaver torsos were obtained. Dissection was started in the midaxillary line bilaterally through the skin and subcutaneous fascia until the external oblique was encountered. The thoracolumbar nerves were identified and measurements were obtained. A peritoneal dissection from the costal margin to pubic symphysis was performed and the vascular pedicle was identified for subsequent microsurgical anastomosis.

RESULTS: The mean size of the abdominal wall graft harvested was 615 ± 120 cm(2). The mean time of abdominal wall procurement was ∼150 ± 12 minutes. The mean number of thoracolumbar nerves identified was 5 ± 1.4 on each side. The mean length of the skeletonized thoracolumbar nerves was 7.8 ± 1.7 cm. The cross-sectional diameter of all nerves as they entered the rectus abdominis was greater than 2 mm.

CONCLUSIONS: Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.

Original languageEnglish (US)
Pages (from-to)39-44
Number of pages6
JournalJournal of Reconstructive Microsurgery
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Composite Tissue Allografts
Abdominal Wall
Vascularized Composite Allotransplantation
Dissection
Kinesthesis
Pubic Symphysis
Nerve Transfer
Transplants
Anatomic Models
Torso
Rectus Abdominis
Fascia
Recovery of Function
Feasibility Studies
Cadaver
Blood Vessels
Hand
Transplantation
Skin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{19693648cef9456cb0a1641a4db50164,
title = "Functional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft: a cadaveric study and review of the literature",
abstract = "BACKGROUND: Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications.METHODS: Three fresh cadaver torsos were obtained. Dissection was started in the midaxillary line bilaterally through the skin and subcutaneous fascia until the external oblique was encountered. The thoracolumbar nerves were identified and measurements were obtained. A peritoneal dissection from the costal margin to pubic symphysis was performed and the vascular pedicle was identified for subsequent microsurgical anastomosis.RESULTS: The mean size of the abdominal wall graft harvested was 615 ± 120 cm(2). The mean time of abdominal wall procurement was ∼150 ± 12 minutes. The mean number of thoracolumbar nerves identified was 5 ± 1.4 on each side. The mean length of the skeletonized thoracolumbar nerves was 7.8 ± 1.7 cm. The cross-sectional diameter of all nerves as they entered the rectus abdominis was greater than 2 mm.CONCLUSIONS: Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.",
author = "Broyles, {Justin M.} and Jens Berli and Sami Tuffaha and Sarhane, {Karim A.} and Damon Cooney and Frederic Eckhauser and Lee, {W P Andrew} and Gerald Brandacher and Singh, {Devinder P.} and Sacks, {Justin Michael}",
year = "2015",
month = "1",
day = "1",
doi = "10.1055/s-0034-1381958",
language = "English (US)",
volume = "31",
pages = "39--44",
journal = "Journal of Reconstructive Microsurgery",
issn = "0743-684X",
publisher = "Thieme Medical Publishers",
number = "1",

}

TY - JOUR

T1 - Functional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft

T2 - a cadaveric study and review of the literature

AU - Broyles, Justin M.

AU - Berli, Jens

AU - Tuffaha, Sami

AU - Sarhane, Karim A.

AU - Cooney, Damon

AU - Eckhauser, Frederic

AU - Lee, W P Andrew

AU - Brandacher, Gerald

AU - Singh, Devinder P.

AU - Sacks, Justin Michael

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications.METHODS: Three fresh cadaver torsos were obtained. Dissection was started in the midaxillary line bilaterally through the skin and subcutaneous fascia until the external oblique was encountered. The thoracolumbar nerves were identified and measurements were obtained. A peritoneal dissection from the costal margin to pubic symphysis was performed and the vascular pedicle was identified for subsequent microsurgical anastomosis.RESULTS: The mean size of the abdominal wall graft harvested was 615 ± 120 cm(2). The mean time of abdominal wall procurement was ∼150 ± 12 minutes. The mean number of thoracolumbar nerves identified was 5 ± 1.4 on each side. The mean length of the skeletonized thoracolumbar nerves was 7.8 ± 1.7 cm. The cross-sectional diameter of all nerves as they entered the rectus abdominis was greater than 2 mm.CONCLUSIONS: Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.

AB - BACKGROUND: Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications.METHODS: Three fresh cadaver torsos were obtained. Dissection was started in the midaxillary line bilaterally through the skin and subcutaneous fascia until the external oblique was encountered. The thoracolumbar nerves were identified and measurements were obtained. A peritoneal dissection from the costal margin to pubic symphysis was performed and the vascular pedicle was identified for subsequent microsurgical anastomosis.RESULTS: The mean size of the abdominal wall graft harvested was 615 ± 120 cm(2). The mean time of abdominal wall procurement was ∼150 ± 12 minutes. The mean number of thoracolumbar nerves identified was 5 ± 1.4 on each side. The mean length of the skeletonized thoracolumbar nerves was 7.8 ± 1.7 cm. The cross-sectional diameter of all nerves as they entered the rectus abdominis was greater than 2 mm.CONCLUSIONS: Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.

UR - http://www.scopus.com/inward/record.url?scp=84942596112&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942596112&partnerID=8YFLogxK

U2 - 10.1055/s-0034-1381958

DO - 10.1055/s-0034-1381958

M3 - Article

C2 - 25184615

AN - SCOPUS:84942596112

VL - 31

SP - 39

EP - 44

JO - Journal of Reconstructive Microsurgery

JF - Journal of Reconstructive Microsurgery

SN - 0743-684X

IS - 1

ER -