Total Abdominal Wall Transplantation: An Anatomical Study and Classification System

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.