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J Reconstr Microsurg 2022; 38(06): 481-490
DOI: 10.1055/s-0041-1740121
Original Article

Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

Valeria P. Bustos 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Joseph M. Escandón 
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Eric Santamaría
3   Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Cancer Institute, Mexico City, Mexico
,
Pedro Ciudad
4   Department of Plastic, Reconstructive, and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
,
Antonio J. Forte
5   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, Florida
,
Roberto Hernandez-Alejandro
6   Division of Abdominal Transplantation and Hepatobiliaty Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Jonathan I. Leckenby
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Howard N. Langstein
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Oscar J. Manrique
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
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Abstract

Background Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes.

Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted.

Results A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy.

Conclusion AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.

Keywords

abdominal wall - composite allotransplantation - abdominal wall allotransplantation - abdominal wall vascularized composite transplantation

Ethical Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Author Contributions

Conception and design were done by Oscar J. Manrique, Valeria P. Bustos, and Joseph M. Escandón. Administrative support was provided by Oscar J. Manrique. Provision of study materials or patients, collection and assembly of data, and data analysis and interpretation were done by Oscar J. Manrique, Valeria P. Bustos, and Joseph M. Escandón. All the authors were involved in writing the manuscript and gave approval to the final manuscript.


Supplementary Material



Publication History

Received: 26 April 2021

Accepted: 26 September 2021

Article published online:
14 December 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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