title: Novel technique for innervated abdominal wall vascularized composite allotransplantation: a separation of components approach.
abstract: OBJECTIVE
  Applications for Abdominal Wall Vascularized Composite Allotransplantation may expand if a functional graft with decreased immunosuppressive requirements can be designed. We hypothesize that it is anatomically feasible to prepare a functional, innervated, and vascularized abdominal composite graft using a multilayered component separation technique. Including vascularized bone in the graft design may decrease the immunosuppressive requirements by inducing immunologic chimerism.
  
  
  METHODS
  Two cadaver torsos were used. Adipocutaneous flaps were elevated from the midaxillary lines, preserving deep inferior epigastric artery perforators. A 2-layered component separation through the external and internal oblique fasciae was carried out, exposing segmental intercostal thoracolumbar nerves. Superiorly directed muscle release over the subcostal margin provided for a 3-rib segment with attached rectus abdominis muscle. The remainder of the full-thickness allograft was harvested with its vasculature. Flap inset into the recipient cadaver abdomen, with osteosynthesis fixation between donor and recipient ribs, was achieved.
  
  
  RESULTS
  The harvested grafts had an average size of 845 ± 205 cm(2) with a total procurement time of 110 minutes. On one cadaver, 4 thoracolumbar nerves were isolated bilaterally, while the other cadaver yielded 3 nerves. The nerves were transected with an average length of 5.7 ± 1.2 cm. The graft vasculature was transected with a length of 4.40 ± 0.10 cm.
  
  
  CONCLUSIONS
  Using the principles of component separation technique, we demonstrated a novel approach to harvest and transfer a neurotized osteomyofasciocutaneous abdominal wall allotransplant as a multipedicled, single functional unit.
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Vasilios D
authors.initials: VD
authors.lastname: Mavrophilipos
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Zapora
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Jens
authors.initials: J
authors.lastname: Berli
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Justin
authors.initials: J
authors.lastname: Broyles
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sabino
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Jamil
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: E Bryan
authors.initials: EB
authors.lastname: Buckingham
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: John S
authors.initials: JS
authors.lastname: Maddox
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bluebond-Langner
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
keywords: abdominal wall transplantation; chimerism; component separation; hernia; vascularized composite allotransplantation