Procurement for a Vascularized and Reinnervated Abdominal Wall Allotransplantation

Extensive and complex abdominal wall defects, particularly those associated with intestinal or visceral organ damage, pose significant medical and surgical challenges. An ideal reconstruction must restore anatomy, function, sensation, and body image. Currently, no conventional reconstruction method fulfills all these criteria in such complex scenarios. However, vascularized composite allotransplantation (VCA) offers a unique solution, providing satisfactory anatomical and functional outcomes -- albeit at the cost of lifelong immunosuppression. Since the first reported human case in 2003, approximately 40 abdominal wall transplants have been performed worldwide, all in conjunction with intestinal or multivisceral transplantation. While various technical adaptations have been described, the procedure has proven to be both safe and effective for patients with complex abdominal wall defects. To date, no reinnervated abdominal wall allograft has been attempted in humans. However, reinnervation appears to be the next frontier, with the potential to enhance functional outcomes and reduce complications. This protocol outlines a standardized procedure for harvesting and preparing a vascularized abdominal wall composite allograft, designed to ensure optimal results and minimize tissue damage. The graft, vascularized via the deep inferior epigastric vessels, is harvested with generous margins to enable tension-free reconstruction. We also detail the specific steps required to collect an innervated specimen. At the end of the procedure, the two deep inferior epigastric arteries are cannulated, and the graft is perfused with preservation solution for transport. Ultimately, this protocol aims to standardize abdominal wall graft procurement. It is intended as a valuable resource for both translational research and clinical applications, particularly as interest in abdominal wall transplantation continues to grow.