Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Reconstruction of Abdominal Wall Defects Using Neurotized Vascularized Composite Allografts
Justin M. Broyles, MD, Karim A. Sarane, M.D., Sami H. Tuffaha, M.D., Damon S. Cooney, M.D., P.h.D., W.P. Andrew Lee, M.D., Gerald Brandacher, M.D., Justin M. Sacks, M.D..
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE:
Abdominal wall vascularized composite tissue allotransplantation (AW-VCA) is the second most common form of VCA after upper extremity transplantation. Sensory and motor recovery is expected in other forms of VCA; however, this has never been demonstrated in AW-VCA. Our purpose was to create a clinically translatable animal model for an innervated AW-VCA that retains both form and sensorimotor function.
METHODS:
Male 10-week old Brown Norway rats and 10-week old Lewis rats were used for experiments. A large, composite abdominal wall alloflap containing skin, fascia, muscles, and nerves based upon the common iliac artery was harvested. The rat donor’s common iliac vessels were anastomosed to recipient’s femoral vessels. Intercostal nerves T10/L1 were coapted using 12-0 nylon suture. Four groups (n=5 per group) were included for study. Group 1=Intercostal nerves cut, not repaired. Group 2=Intercostal nerves cut, T10/L1 repaired. Group 3= Allogeneic, Full MHC-mismatch AW-VCA, T10/L1 repaired. Group 4=Syngeneic AW-VCA, T10/L1 repaired. Allogeneic transplants were maintained on FK-506 monotherapy (0.5mg/kg/day intraperitoneally) with no episodes of rejection. Animals were sacrificed on POD 60. Nerve regeneration was assessed using muscle weight and electromyographic analysis, rectus abdominis laminin cross sectional area (CSA), and neuromuscular junction percent reinnervation. (Figure 1)
RESULTS:
Groups 2, 3, and 4 maintained a significantly greater percentage of post-harvest weight when compared with Group 1 (0.22, 0.21, 0.23 vs. 0.16, p<0.05).
Group 1 had significantly decreased CSA when compared with internal, contralateral controls. (3171.0µm2 vs. 4453.0 µm2, p<0.05). There was no significant difference in CSA in Group 2 when compared with contralateral controls (4665.0 µm2 vs. 3171.0 µm2, p>0.05). (Figure 2) Furthermore, there was no difference in CSA in Groups 3 or 4 when compared with contralateral control groups (2424.0µm2 vs. 2437.0µm2, p>0.05; 2624.0µm2 vs. 2637.0µm2, p>0.05). (Figure 3)
Group 1 had significantly decreased percent reinnervation of the alloflap when compared to contralateral controls (21% vs. 91%, p<0.05). There was no significant difference when comparing Group 2, 3, or 4 with contralateral controls (80% vs. 91%, p>0.05; 82% vs. 91%, p>0.05, 83% vs. 91%, p>0.05). (Figure 4)
CONCLUSION:
To our knowledge, this is the first report of a neurotized abdominal wall transplant to reconstruct large abdominal wall defects. Coaptation of T10/L1 will provide for motor and sensory recovery of the alloflap. This animal model will lead to improved clinical outcomes and expanded indications in an already an established human transplant model.




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