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Updated: Mar 1, 2026

Procurement for a Vascularized and Reinnervated Abdominal Wall Allotransplantation
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Total Abdominal Wall Transplantation: An Anatomical Study and Classification System.

David Light1,2, Neilendu Kundu1,2, Risal Djohan1,2

  • 1Cleveland, Ohio.

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|May 25, 2017
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Summary

This study details a dissection technique for abdominal wall reconstruction using vascularized composite flaps, offering a new classification for complex defects. Improved lateral perfusion was noted with intact deep circumflex iliac artery preservation.

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Area of Science:

  • Surgical innovation in reconstructive transplantation.
  • Anatomy and vascular supply of abdominal wall.
  • Composite tissue allotransplantation.

Background:

  • Complex abdominal wall defects often exceed traditional reconstructive capabilities.
  • Multivisceral transplantation candidates present unique challenges.
  • Need for advanced reconstructive options in transplantation.

Purpose of the Study:

  • To describe a dissection technique for a total abdominal wall vascularized composite flap.
  • To propose a classification system for complex abdominal wall defects.
  • To evaluate flap perfusion patterns.

Main Methods:

  • Dissection of 40 fresh, cadaveric hemiabdomens.
  • Preservation of key abdominal wall arteries and veins.
  • Computed tomographic angiography to assess flap perfusion.

Main Results:

  • Identified major abdominal arteries (DCIA, SCIA, DIEA, SIEA) originating from a 5-cm iliofemoral artery cuff.
  • Preservation of the deep circumflex iliac artery (DCIA) improved lateral flap perfusion.
  • Demonstrated feasibility of harvesting a total abdominal wall flap.

Conclusions:

  • Proposed an algorithm for abdominal wall reconstruction based on defect size and perfusion.
  • Technique for harvesting a total vascularized composite abdominal wall flap for allotransplantation.
  • Total abdominal wall transplantation is a viable option for select transplant patients with defects.