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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jens
authors.initials: J
authors.lastname: Berli
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Karim A
authors.initials: KA
authors.lastname: Sarhane
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Damon S
authors.initials: DS
authors.lastname: Cooney
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Frederic E
authors.initials: FE
authors.lastname: Eckhauser
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: W P Andrew
authors.initials: WP
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D034861:Abdominal Wall / Q000294:innervation* / Q000473:pathology; D002102:Cadaver; D005205:Fascia / Q000637:transplantation*; D006801:Humans; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000637:transplantation*; D063986:Vascularized Composite Allotransplantation / Q000379:methods*