The extended abdominal wall flap for transplantation

Area of Science:

• Vascular surgery
• Reconstructive surgery
• Anatomy

Background:

• Extensive abdominal wall defects present significant reconstructive challenges.
• Current options for large-scale abdominal wall reconstruction are limited.
• Composite tissue allotransplantation is used for limited reconstruction but not total abdominal wall replacement.

Purpose of the Study:

• To determine the maximum abdominal skin surface area achievable via an external iliac/femoral cuff-based pedicle.
• To compare flap perfusion using an external iliac/femoral artery cuff versus the deep inferior epigastric artery (DIEA) alone.

Main Methods:

• Human cadaveric abdominal walls were dissected.
• Methylene blue was used to analyze skin perfusion.
• Perfusion was assessed using either the deep inferior epigastric artery (DIEA) or an external iliac/femoral artery cuff supplying key abdominal arteries.

Main Results:

• All analyzed arteries (deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, superficial circumflex iliac) originated within a 4-cm cuff of the external iliac/femoral artery.
• Abdominal wall flaps achieved significantly greater total flap perfusion when supplied by the external iliac/femoral segment (76.5% ± 4%) compared to the DIEA alone (57.2% ± 5%).

Conclusions:

• A large portion of the abdominal wall can be perfused using a single-vessel anastomosis from the external iliac/femoral artery system.
• This approach offers significantly greater perfusion compared to relying solely on the DIEA for abdominal wall reconstruction.