Name: An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps (Video) | JoVE Journal
Uploaded: 2025-12-05T13:15:00.000+00:00
Duration: 7 min 57 s
Description: Learn the surgical technique for harvesting human DIEP perforator flaps to improve preservation of vascularized composite allografts. This method advances experimental surgery research.

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<ol><li>Lupon, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((vascularized+composite+allografts+in+france%3A+An+update%5BTitle%5D)+AND+%22Ann+Chir+Plast+Esthet%22%5BJournal%5D)">vascularized composite allografts in france: An update.</a> Ann Chir Plast Esthet. , (2024).</li>
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<li>Lupon, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Perforator+identification+for+propeller+flap+harvest%3A+Technical+insights+from+a+case+serie%5BTitle%5D)+AND+%22Int+J+Surg+Case+Rep%22%5BJournal%5D)">Perforator identification for propeller flap harvest: Technical insights from a case serie.</a> Int J Surg Case Rep. 135, 111921(2025).</li>
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<li>Lupon, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgery+in+low-+and+middle-income+countries%3A+Results+of+20+years+of+experience+in+cambodia%5BTitle%5D)+AND+%22J+Plast+Reconstr+Aesthet+Surg%22%5BJournal%5D)">Microsurgery in low- and middle-income countries: Results of 20 years of experience in cambodia.</a> J Plast Reconstr Aesthet Surg. 98, 161-169 (2024).</li>
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</ol>

The authors have nothing to disclose.

Human models help bridge findings from animal studies to clinical practice, improving the relevance and predictivity of preclinical research16,17,18. They must be carefully designed to ensure safety and ethical compliance, often limiting the scope and invasiveness of experiments17. Across the four harvested flaps, no additional dissection was necessary, and there was no significant prolongation of operati...

Vascularized composite allotransplantation (VCA) represents a promising reconstructive solution for patients with complex tissue defect, particularly in the face and upper limbs1. However, VCA is highly susceptible to ischemia-reperfusion injury, which can compromise graft viability and long-term outcomes2. In this context, preservation approaches such as cytoprotective agents injection, ex vivo machine perfusion, and supercooling have emerged as strategies to extend preservation time, optimize graft quality, and enable viability assessment prior to transplantation3,4,5,6,7. While normothermic ex vivo perfusion of solid organs has been successfully translated from an experimental laboratory technique into clinical practice over the past decade8, with promising results, it remains largely confined to the research setting in the field of VCA9.
To date, most studies investigating VCA perfusion protocols have relied on animal models, particularly swine or rodent composites10. While these models offer valuable insights, they inherently limit reproducibility and translational relevance due to anatomical, immunological, and physiological differences11,12. Human tissue models provide more relevant insights, but fresh tissues from brain-dead donors are extremely difficult to access for research purposes, requiring complex logistics, strict regulatory approval, and raising ethical concerns13,14. An ideal alternative would be a non-cadaveric, ethically acceptable, human-based flap model that does not carry the complexity or risk of a full VCA procedure and is entirely safe for the patient. Importantly, it should also be easily accessible to facilitate reproducible, scalable research.
Herein, a human deep inferior epigastric perforator (DIEP) flap model for VCA preservation research is described, using discarded tissue from abdominoplasty procedures without any additional risk to the patient.

<table><tbody><tr><td>1 mL and 5 mL Luer-Lok syringe</td><td>Becton Dickinson</td><td>https://www.bd.com/en-us/products-and-solutions/products/product-page.309646</td><td></td></tr><tr><td>11.5&amp;rdquo; Medium and Small Premium Surgiclip II Auto Suture vessel clip applier</td><td>Covidien</td><td>N/A</td><td></td></tr><tr><td>22&amp;ndash;24 G vessel cannula blunt tip</td><td>Medtronic Inc</td><td>N/A</td><td></td></tr><tr><td>5-0 silk suture&amp;nbsp;</td><td></td><td>N/A</td><td>Any compatible suture</td></tr><tr><td>A single-use, battery-powered disposable cautery pen&amp;nbsp;</td><td>Helpmedical, Europe</td><td>N/A</td><td>1200 &amp;deg;C, large-tip</td></tr><tr><td>Adson Forceps</td><td>MPM</td><td>106-2112A</td><td></td></tr><tr><td>Bipolar Coagulation Forceps</td><td>Olsen</td><td>20-1320I</td><td></td></tr><tr><td>Disposable Scalpel #15 &amp;amp; #21</td><td>Sklar</td><td>N/A</td><td></td></tr><tr><td>Eosin&amp;nbsp;</td><td>Microm Microtech</td><td>U/C0363</td><td></td></tr><tr><td>Faraboeuf retractors</td><td>Medicta Instruments</td><td>N/A</td><td></td></tr><tr><td>Fine needle cautery</td><td>Cormedica</td><td>N/A</td><td></td></tr><tr><td>OEC MiniView Max</td><td>GE Healthcare</td><td>N/A</td><td>Fluoroscopy system</td></tr><tr><td>Forceps Dilators</td><td>WPI</td><td>15910</td><td></td></tr><tr><td>Hematoxylin&amp;nbsp;</td><td>Microm Microtech</td><td>U/C0303</td><td></td></tr><tr><td>Iohexol 300 mg I/mL</td><td>GE Healthcare Canada Inc.</td><td>N/A</td><td></td></tr><tr><td>Micro scissors</td><td>WPI</td><td>504492</td><td></td></tr><tr><td>Valleylab Monopolar Diathermy</td><td>Medtronic Inc</td><td></td><td></td></tr><tr><td>Non-ionic iodinated contrast medium, Omnipaque 300 mg I/mL</td><td>GE Healthcare</td><td>N/A</td><td></td></tr><tr><td>Portable acoustic Doppler, 8 MHz</td><td>Parks Medical Electronics</td><td>https://www.parksmed.com/</td><td></td></tr><tr><td>Saline solution 0.9%</td><td>GenDepot</td><td>S0600-101</td><td></td></tr><tr><td>Standard plastic surgery instrument set</td><td>Aesculap</td><td>N/A</td><td>including scalpel handle No. 3, Metzenbaum and Mayo scissors, Adson and Gillies forceps, dissecting scissors, hemostats, and needle holders.</td></tr><tr><td>Strabismus scissors</td><td>Surtex</td><td>102-4109</td><td></td></tr><tr><td>Surgical marking pen</td><td>Cardinal health</td><td>212PR</td><td></td></tr><tr><td>Sutures Ethilon 4.0 and 3.0</td><td>Ethicon</td><td>1667G</td><td></td></tr><tr><td>Tissue Forceps</td><td>MPM</td><td>106-0511</td><td></td></tr></tbody></table>

an experimental human diep flap model to investigate preservation strategies for vascularized composite allografts and free flaps

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

Recently, preservation approaches such as cytoprotective agents injection, ex vivo machine perfusion, and supercooling have emerged as strategies to enhance long-term preservation of both standard and marginal organs by mitigating ischemic and hypoxic injury. Although encouraging, its application in the field of vascularized composite allotransplantation (VCA) remains largely confined to preclinical research. To date, most studies investigating VCA perfusion strategies have relied on animal models, particularly swine or rodent composites. While these models provide valuable mechanistic insights, their anatomical, immunological, and physiological differences limit reproducibility and translational relevance to human applications.
In this protocol, each surgical step required for the procurement of a human deep inferior epigastric perforator (DIEP) flap for preservation studies is described in detail. The perforator is transected above the fascia without any subfascial dissection, yielding a short yet sufficient pedicle for catheterization. This model takes advantage of discarded tissue from standard abdominoplasty procedures, posing no additional risk to the patient. Critical steps are outlined to ensure a functional flap is harvested without prolonging operative time or compromising patient safety. Functional imaging is subsequently performed to confirm flap viability prior to experimental use, and sequential biopsies may be performed to follow tissue integrity. This model is particularly suited for research involving muscle-sparing VCA procedures -- such as partial facial transplantation -- and may also have relevance for the study of autologous free flap preservation.

Eleven flaps were harvested from six female patients included in this study. Two senior plastic surgeons, experienced in flap surgery and abdominoplasty, performed the dissections. In one patient, the flap was harvested unilaterally due to a dissection issue. The harvested flaps had a mean weight of 198.6 ± 24.4 g (n = 11) and an average size of 10 cm × 6 cm, which corresponded to the sample requirements for the preservation study in which these flaps were used. The pedicle length, measured under gentle tension, averaged...

This protocol describes the surgical technique for harvesting a human perforator flap model based on the deep inferior epigastric artery pedicle, intended for experimental research.

Recently, preservation approaches such as cytoprotective agents injection, ex vivo machine perfusion, and supercooling have emerged as strategies to ...

Our study aims to improve preservation and survival of vascularized composite allografts, and free flaps using human experimental flaps models. Current research mainly relies on animal VCA and free flap models, often using rodent or large animal hand/limb osteomyocutaneous flaps. To begin, perform the preoperative dermal lipectomy marking with the patient and identify the midline from the pubic synthesis to the xiphoid process.Draw a transverse line approximately seven centimeters above the vulvar commissure. Extend this line laterally about seven centimeters on each side, gently curving it upward to join just below the anterior superior iliac spines. Identify the perforators around the umbilicus using a handheld acoustic doppler probe with eight to 10 megahertz while the patient is in the supine position.Using a dermographic pen, outline a skin paddle in an elliptical shape of the desired dimensions, including the perforator along its medial border, and extending on both sides of the umbilicus. Prepare and drape the surgical field from the xiphoid process to the upper third of the thighs, including the pubic region, using sterile surgical drapes as routinely performed in standard

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Research

JoVE Journal

Medicine

Free tissue transfer is widely employed in reconstructive surgery to restore form and function following oncological resection and trauma. Preconditioning this tissue prior to surgery may improve outcome. This article describes an in situ transverse rectus abdominis myocutaneous flap (TRAM) in rats as a means for testing preconditioning strategies.

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

The window of the murine dorsal skinfold chamber presented visualizes a zone of acute persistent ischemia of a musculocutaneous flap. Intravital epi-fluorescence microscopy permits for direct and repetitive assessment of the microvasculature and quantification of hemodynamics. Morphologic and hemodynamic results can further be correlated with histological and molecular analyses.

Ischemic Tissue Injury in the Dorsal Skinfold Chamber of the Mouse: A Skin Flap Model to Investigate Acute Persistent Ischemia

To date, thick tissue defects are typically reconstructed by applying autologous tissue flaps or engineered tissues. In this protocol, we present a new method for engineering vascularized tissue flap bearing an autologous pedicle, to serve as a substitute to autologous flaps.

Engineered Vascularized Muscle Flap

This paper describes the steps required to raise a fasciocutaneous epigastric free flap and transfer it to the neck in the rat.

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Here we present a protocol for the use of the pig superior epigastric artery perforator flap as a learning module for head and neck microvascular reconstruction.

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

Vascularized composite allograft offers life-altering benefits to transplant recipients, but the biological causes of graft rejection and vasculopathy remain poorly understood. The rodent surgical model presented here offers a reproducible, clinically relevant model of transplantation, allowing researchers to evaluate rejection events and potential therapeutic strategies to prevent their occurrence.

Modified Heterotopic Hindlimb Osteomyocutaneous Flap Model in the Rat for Translational Vascularized Composite Allotransplantation Research

Here, we describe a pre-clinical animal model for studying the pathophysiology of ischemia-reperfusion injury in reconstructive microsurgery. This free skin flap model based on the superficial caudal epigastric vessels in the rat may also allow for the evaluation of different therapies and compounds to counteract ischemia-reperfusion injury-related damage.

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

The present protocol describes the porcine fascio-cutaneous flap model and its potential use in vascularized composite tissue research.

A Reliable Porcine Fascio-Cutaneous Flap Model for Vascularized Composite Allografts Bioengineering Studies

The protocol describes the surgical procurement and subsequent decellularization of vascularized porcine flaps by the perfusion of sodium dodecyl sulfate detergent through the flap vasculature in a customized perfusion bioreactor.

Procurement and Perfusion-Decellularization of Porcine Vascularized Flaps in a Customized Perfusion Bioreactor

This protocol describes harvesting, suturing, and monitoring fasciocutaneous flaps in rats that allow for good visualization and manipulation of blood flow through the superficial inferior epigastric vessels by means of clamping and ligating the femoral vessels. This is critical for studies involving ischemic preconditioning.

The Superficial Inferior Epigastric Artery Axial Flap to Study Ischemic Preconditioning Effects in a Rat Model

This protocol details the surgical technique used to harvest and prepare a full-face allograft for transplantation in patients with severe facial disfigurements, focusing primarily on soft tissue procurement with limited bony harvest restricted to the nasal framework.

Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation

Learn the surgical technique for harvesting human DIEP perforator flaps to improve preservation of vascularized composite allografts. This method advances experimental surgery research.

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps (Video) | JoVE Journal

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

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