Transplantation of vascularized allogeneic skeletal muscle for scalp reconstruction in a renal transplant patient.

BACKGROUND

We report the case of a vascularized allogeneic skeletal muscle transplant (VASM) and autologous skin grafting as rescue therapy for refractory squamous cell carcinoma of the scalp.

METHODS

A renal transplant recipient with recurrent squamous carcinoma of the scalp underwent an excision that resulted in a 11 x 14 cm2 scalp defect with exposed cranium. At the time of multiorgan procurement, a section of rectus abdominis and external oblique muscle and fascia with its independent vascular bundle was isolated and stored in cold University of Wisconsin solution. The patient received methylprednisolone and rabbit antithymocyte globulin intravenously during scalp preparation, before single-vessel anastomosis of the deep inferior epigastric vascular bundle from the donor muscle to the recipient neck vessels. An autologous split-thickness skin graft was secured to the surface of the allogeneic muscle.

RESULTS

Immunosuppression was maintained with prednisone and cyclosporine. Serial VASM biopsies were used to evaluate acute rejection. Perivascular lymphocytic infiltrates and rare focal myonecrosis were evident on biopsy at 2 weeks postoperatively, and mycophenolate mofetil was added. Subsequent VASM biopsies showed predominately interstitial and perivascular T-cell lymphocytic infiltrates interpreted as consistent with mild rejection, but the allograft appeared intact without clinical evidence of rejection. On postoperative week 18, the mycophenolate mofetil was discontinued. There has been no evidence of recurrence or metastasis. The patient remains ambulatory with a healed scalp 12 months after the VASM.

CONCLUSION

The success of this first allogeneic skeletal muscle transplant is encouraging and provides another reconstruction option for wounds in transplant patients on chronic immunosuppression.