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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(01): e97-e101
DOI: 10.1055/a-2320-5368
Case Report

Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at 4-Year Follow-up

Nicholas C. Oleck
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Ralph F. Erdmann
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Kadiyala V. Ravindra
2   Division of Abdominal Transplant Surgery, Duke University Medical Center, Durham, North Carolina
,
Debra L. Sudan
2   Division of Abdominal Transplant Surgery, Duke University Medical Center, Durham, North Carolina
,
Brett T. Phillips
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Suhail K. Mithani
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Detlev Erdmann
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Andrew Atia
1   Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
› Author Affiliations Funding None.
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Abstract

This 4-year follow-up of synchronous abdominal wall vascular composite allotransplantation (AW-VCA) and small bowel transplantation reveals novel insights and innovations in abdominal wall VCA. The case, involving a 37-year-old male Army veteran, showcases the benefits of AW-VCA in addressing loss of abdominal domain in intestinal transplantation (ITx). The events leading to ultimate rejection of both the AW-VCA and small bowel graft at 4 years highlights the complex interplay between graft survival, patient compliance, and immunosuppressive management. Notably, a significant discordance between AW-VCA and ITx rejection patterns was identified, questioning the reliability of skin components in AW-VCA as early indicators of ITx rejection. Furthermore, the behavior of the vascularized abdominal fascia, observed postexcision of the small bowel graft, offers new understanding of the immunologic response to fascia-only grafts. This follow-up emphasizes the complexities of graft survival, patient compliance, and immunosuppressive management, underscoring the need for ongoing research and innovation in the field.

Keywords

abdominal wall transplant - VCA - abdominal wall reconstruction

Previous Presentation

This work has been presented in parts at the American Society of Reconstructive Microsurgery (ASRM) annual meeting, Nassau, Bahamas on January 12–16, 2024.




Publication History

Received: 08 March 2024

Accepted: 15 April 2024

Accepted Manuscript online:
06 May 2024

Article published online:
11 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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