Reconstruction of Large Composite Abdominal Wall Defects Using Neurotized Vascular Composite Allografts
Justin M. Broyles, MD1, Karim A. Sarhane, M.D.1, Sami H. Tuffaha, M.D.1, Damon S. Cooney, M.D., P.h.D.1, Devinder P. Singh, M.D.2, W.P. Andrew Lee, M.D.1, Gerald Brandacher, M.D.1, Justin M. Sacks, M.D.1.
1The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2The University of Maryland Medical School, Baltimore, MD, USA.
Abdominal wall vascularized composite tissue allotransplantation (AW-VCA) is a common form of VCA. Functional recovery is expected in VCA; however, this has never been demonstrated in AW-VCA. Our purpose was to create a translatable animal model for an innervated AW-VCA that retains form and function.
The rat donor’s common iliac vessels were anastomosed to recipient’s femoral vessels. Intercostal nerves T10/L1 were coapted using nylon suture. (Figure 1) Four groups (n=5/group) were included for study. Group 1=Intercostal nerves cut, not repaired. Group 2=Intercostal nerves cut, T10/L1 repaired. Group 3=Allogeneic AW-VCA, T10/L1 repaired. Group 4=Syngeneic AW-VCA, T10/L1 repaired. Animals were sacrificed on POD 60. Nerve regeneration was assessed using muscle weight, laminin cross sectional area (CSA), and neuromuscular junction percent reinnervation.
Groups 2, 3, and 4 maintained a greater percentage of muscle weight when compared with Group 1 (.22, .21, .23 vs. .16, p<0.05).
Group 1 had decreased CSA when compared with contralateral controls (3171µm2 vs 4453µm2, p<0.05).
Group 1 had decreased percent reinnervation of the alloflap when compared to internal controls (21% vs. 91%, p<0.05) There was no difference between Groups 3 or 4 with internal controls (80% vs. 91%, p>0.05; 82% vs. 91%, p>0.05).
In a rodent model, coaptation of T10/L1 will provide for motor and sensory recovery of the alloflap. Human AW-VCA will potentially benefit from neurotization of the alloflap.
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