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Optimizing Vascularized Composite Allograft Viability with Novel Preservation
Abigail M Royfman BS, Dominika Pullmann MD, Sachin Chinta BS, Alay R Shah MD, Piul S Rabbani PhD
Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine
2025-01-06
Presenter: Abigail M Royfman
Affidavit:
Abigail Royfman aided in the design of the study, data acquisition, analysis and interpretation of the data, and drafted the abstract.
Director Name: Piul S Rabbani
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: Vascularized composite allografts (VCAs) offer a promising solution for complex reconstructive cases, but successful transplantation is limited to a 4 to 6-hour preservation window. This study evaluates the efficacy of supplementing the standard University of Wisconsin (UW) preservation solution with adipose-derived stem cell-conditioned media (ADSC-CM), referred to as UW-CM, for graft preservation using a novel histopathological injury scoring system (HISS)
Methods: Rat osteomyocutaneous grafts, comprising a superficial inferior epigastric artery skin flap, vascularized muscle, and femur, were perfused with and stored in three conditions: 1) saline, 2) UW, or 3) UW-CM. Graft muscle viability was assessed using hematoxylin and eosin (H&E) staining and a histological scoring system based on endomysium and fiber appearance (1 = normal, 2 = mild/moderate degradation, 3 = severe degradation). Comparisons were performed using descriptive statistics, and inter-rater reliability was evaluated using Cohen's Kappa.
Results: At 6-hours, the Saline group had the highest median score of 2.5, indicating more muscle injury, while UW (1.42) and UW-CM (1.5) demonstrated lower scores, suggesting better preservation. At 48 hours, UW-CM performed slightly better with a median score of 2, compared to UW (2.5). Although not statistically significant (Mann-Whitney test), UW-CM may still offer slight improvements in preservation. Two raters demonstrated substantial inter-rater agreement (0.691) while scoring 84 ROIs across 21 flaps
Conclusion: UW-CM may offer slight improvements in graft preservation compared to UW, warranting further optimization of ADSC-CM concentration and sample size to enhance preservation. The scoring system provides a simple, useful tool for evaluating muscle graft viability.
