title: Vascularized composite allotransplantation: an update on medical and surgical progress and remaining challenges.
abstract: BACKGROUND
  In vascularized composite allotransplantation, multiple types of tissue are transferred from donor to recipient as a single functional unit. This technique has been performed for upper extremity, face, and abdominal wall transplants, among many others.
  
  
  OBJECTIVE
  To review the existing cases of face and upper extremity vascularized composite allotransplantation performed to date and to describe the functional outcomes and challenges associated with this new procedure. We also review the immune suppression protocols required for these procedures.
  
  
  METHODS
  A literature review was performed using PubMed and online registries where available to identify patients who have undergone upper extremity and face transplant procedures. These were compiled and cross-referenced to abstracts, conference presentations, and press releases in the media to create a list of procedures performed to date.
  
  
  RESULTS
  More than seventy patients have undergone upper extremity transplantation with very good functional outcomes routinely achieved. Twenty-five face transplants were identified that have been completed to date and details regarding patient outcome are included. One cases of human face allotransplantation with pre- and post-operative images is included as an example of what can be achieved with this technique.
  
  
  CONCLUSIONS
  Vascularized composite allotransplantation is an emerging field that provides an exciting new avenue for reconstructive procedures and achieves functional and cosmetic outcomes not previously possible with existing techniques. However, it is not without its challenges and considerable work is still required prior to widespread adoption of these new reconstructive techniques.
authors.affiliation: University of Toronto, Division of Plastic and Reconstructive Surgery, Toronto, Canada.
authors.forename: Blake D
authors.initials: BD
authors.lastname: Murphy
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Zuker
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Borschel
mesh_terms: D054445:Facial Transplantation / Q000009:adverse effects; D063987:Hand Transplantation / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D014184:Transplantation, Homologous
keywords: Composite tissue allotransplantation; Face transplant; Hand transplant; Limb transplant; Vascularized composite allotransplantation