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Total Abdominal Wall Transplantation: An Anatomical Study and Classification System

Light, David M.D.; Kundu, Neilendu M.D.; Djohan, Risal M.D., M.B.A.; Quintini, Cristiano M.D.; Gandhi, Namita M.D.; Gastman, Brian R. M.D.; Drake, Richard Ph.D.; Siemionow, Maria M.D.; Zins, James E. M.D.

Plastic & Reconstructive Surgery: June 2017 - Volume 139 - Issue 6 - p 1466–1473
doi: 10.1097/PRS.0000000000003327
Reconstructive: Trunk: Original Article
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Background: Candidates for multivisceral transplantation present with complex defects often beyond traditional reconstructive options. In this study, the authors describe a dissection technique for a total abdominal wall vascularized composite flap. In addition, the authors suggest a classification system for complex abdominal wall defects.

Methods: Forty fresh, cadaveric hemiabdomens were dissected, with care taken to preserve the iliofemoral, deep circumflex iliac, superficial circumflex iliac, deep inferior epigastric, and superficial inferior epigastric arteries and corresponding veins. Perfusion patterns of the flaps were then studied using computed tomographic angiography.

Results: The deep circumflex iliac, superficial circumflex iliac, deep inferior epigastric, and superficial inferior epigastric arteries were identified along a 5-cm cuff of the iliofemoral artery centered on the inguinal ligament. Perfusion with an intact deep circumflex iliac artery yielded improvement in lateral perfusion based on computed tomographic angiography.

Conclusions: The authors propose an algorithm for abdominal wall reconstruction based on defect size and abdominal wall perfusion, and their technique for harvesting a total vascularized composite abdominal wall flap for allotransplantation. Total abdominal wall transplantation should be considered in the subset of patients already receiving visceral organ transplants who also have concomitant abdominal wall defects.

Cleveland, Ohio

From the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, the Department of Hepatobiliary and Transplant Surgery, Digestive Disease Institute, and the Department of Abdominal Diagnostic Radiology, Imaging Institute, Cleveland Clinic; and the Department of Anatomic Studies, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

Received for publication December 1, 2016; accepted December 15, 2016.

Presented at the American Society of Plastic Surgeons Senior Resident Conference, in Tampa, Florida, on January 20, 2012, and winner of the best presentation award.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Neilendu Kundu, M.D., Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk A-60, Cleveland, Ohio 44195,

©2017American Society of Plastic Surgeons