Current status of vascularized composite tissue allotransplantation

Vascularized composite tissue allotransplantation(VCA)offers treatment options of complex functional deficiencies that cannot be repaired with conventional reconstructive methods.VCAs consist of blocks of functional units comprising different tissue types such as skin,bone,muscle,nerves,blood vessels,tendons,ligaments and others,and are thus substantially different from the composition of organ transplants.The field of VCA has made fascinating progresses in the recent past.Among other VCAs,numerous successful hand,face and limb transplants have been performed in the world.At the same time,specific questions in regard to innate and adaptive immunity,consequences of ischemia/reperfusion injury,immunosuppression,preservation,and regenerative capacity remain.In spite of this,the field is poised to make significant advances in the near future.

Current role in facial allograft transplantation:what have we learned?

Face transplant(FT)has evolved enormously in the last 10 years since the successful completion of the first facial transplant.This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces.The authors review the literature and discuss the main surgical,immunological,and ethical aspects as well as the results described in patients undergoing FT.To date there have been more than thirty FT worldwide.The main indication was post-traumatic deformity.In all cases a standard immunosuppression was performed with three drugs,although acute rejection episodes were observed,that could be controlled with conventional immunosuppressive regimen.Overall,functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations,although long-term data are still scarce.Major complications were opportunistic infections.Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients.Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT.All these are on the basis of accurate and careful selection of well-motivated candidates.The next challenge will be getting new immunosuppressive treatment strategies.Although clinical experience has demonstrated the FT viability,it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical,medical and ethical problems involved.