Concomitant Face/Upper Extremity Allotransplantation

Concomitant vascularized composite tissue allotransplantation (VCA) offers single stage restoration of complex anatomical units in a manner that would be difficult, if not impossible to accomplish using conventional reconstructive techniques. However, such extensive and complex transplant procedures have considerable inherent risk. Two cases of concomitant face and hand transplantation have been performed to date, both with significant early complications leading to significant morbidity, and in one case, mortality. These cases highlight some of the unknowns in both perioperative and immunological management that must be addressed if this complex subset of VCA procedures is to be more widely offered. Only once these acute challenges can be reliably managed will focus turn to rehabilitation and long-term outcomes. If these issues can be overcome, concomitant face and upper extremity transplantation could offer patients who have suffered severe, complex injuries unprecedented options for restoration of function and form.