Abstract
Background Abdominal wall vascularized composite allotransplantation (AW-VCA) can be considered
as a technically feasible option for abdominal wall reconstruction in patients whose
abdomen cannot be closed using traditional methods. However, successful initial abdominal
wall revascularization in the setting of visceral organ transplantation can pose a
major challenge as graft ischemia time, operating in a limited surgical field, and
variable recipient and donor anatomy must be considered. Several techniques have been
reported to accomplish abdominal wall revascularization.
Methods A literature review was performed using PubMed for articles related to “abdominal
wall transplantation (AWT).” The authors of this study sorted through this search
for relevant publications that describe abdominal wall transplant anatomy, technical
descriptions, and outcomes of various techniques.
Results A total of four distinct revascularization techniques were found in the literature.
Each of these techniques was described by the respective authors and reported varying
patient outcomes. Levi et al published a landmark article in 2003 that described technical
feasibility of AWT with anastomosis between donor external iliac and inferior epigastric
vessels with recipient common iliac vessels in end-to-side fashion. Cipriani et al
described a microsurgical technique with anastomosis between donor and recipient inferior
epigastric vessels in an end-to-end fashion. Giele et al subsequently proposed banking
the abdominal wall allograft in the forearm to reduce graft ischemia time. Recently,
Erdmann et al described the utilization of an arteriovenous loop for synchronous revascularization
of abdominal wall and visceral transplants for reduction of ischemia time, operative
time, while eliminating the need for further operations.
Conclusion Vascularized composite allotransplantation continues to advance with improving immunotherapy
and outcomes in solid organ transplantation. Optimizing surgical techniques remains
paramount as the field continues to grow. Refinement of the presented methods will
continue as additional evidence and outcomes become available in AW-VCA.
Keywords
abdominal wall transplantation - vascularized composite allotransplantation - microsurgery
- abdominal wall reconstruction - revascularization
