title: Reconstruction of Large Abdominal Wall Defects Using Neurotized Vascular Composite Allografts.
abstract: BACKGROUND
  Abdominal wall vascularized composite allotransplantation is the second most common form of vascularized composite allotransplantation. Sensory and functional recovery are expected in other forms but have never been demonstrated in abdominal wall vascularized composite allotransplantation. The authors hypothesize that coaptation of two thoracolumbar nerves will result in reinnervation of the alloflap and maintenance of the muscle component.
  
  
  METHODS
  Adult, male, 10-week-old Brown Norway and Lewis rats were used for experiments. The rat donor's common iliac vessels were anastomosed to the recipient's femoral vessels. Intercostal nerves T10/L1 were coapted. Four groups (n = 5 per group) were included for study: group 1, Lewis, intercostal nerves cut, not repaired; group 2, Lewis intercostal nerves cut, T10/L1 repaired; group 3, allogeneic Brown Norway-to-Lewis abdominal wall vascularized composite allotransplantation, T10/L1 repaired; and group 4, syngeneic Lewis-to-Lewis abdominal wall vascularized composite allotransplantation, T10/L1 repaired. Animals were killed on postoperative day 60. Nerve regeneration was assessed using muscle weight analysis, myofibril cross-sectional area, nerve histomorphometry, and neuromuscular junction percentage reinnervation.
  
  
  RESULTS
  Groups 2, 3, and 4 maintained a significantly greater percentage of postharvest weight compared with group 1 (p < 0.05). Group 1 had significantly decreased myofibril cross-sectional area compared with controls (p < 0.05). There was no significant difference in myofibril cross-sectional area in groups 2 through 4 compared with controls (p > 0.05). Group 1 had significantly decreased percentage reinnervation of the alloflap compared with controls (p < 0.05). There was no significant difference when comparing group 2 through 4 with internal, contralateral controls (p > 0.05).
  
  
  CONCLUSIONS
  In a murine model for abdominal wall vascularized composite allotransplantation, coaptation of T10/L1 will allow for reinnervation of the alloflap and maintenance of the muscle component.
authors.affiliation: Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.forename: Karim A
authors.initials: KA
authors.lastname: Sarhane
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.forename: Damon S
authors.initials: DS
authors.lastname: Cooney
authors.forename: W P Andrew
authors.initials: WPA
authors.lastname: Lee
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000818:Animals; D064595:Composite Tissue Allografts / Q000098:blood supply / Q000294:innervation*; D007367:Intercostal Nerves / Q000601:surgery; D008297:Male; D009416:Nerve Regeneration; D016067:Nerve Transfer / Q000379:methods*; D051381:Rats; D011914:Rats, Inbred BN; D011917:Rats, Inbred Lew; D013900:Thoracic Nerves / Q000601:surgery; D063986:Vascularized Composite Allotransplantation / Q000379:methods*