Vascularized Composite Allotransplantation (VCA) is the technical term for what we do to restore the function and appearance of our patients’ severely injured facial structures or limbs. VCA involves the transfer of functional non-organ structures containing multiple tissue components – such as a face, hand, arm, or leg – from a donor to restore the damaged face or limbs of a recipient.
During a restorative procedure, one surgical team works on removing the composite graft (a functional unit of multiple tissues), such as a face or limb, from the donor as another team simultaneously prepares the area on the recipient where the face or limb is going to be reattached. For face transplant surgery, the transplant could include the nose, lips, and other soft tissues of the face, including all its blood vessels, muscles, and nerves, and portions of the facial skeleton. For hand transplant surgery, the transplant could include skin, tendons, muscles, ligaments, bones, and blood vessels. Surgeons then connect the graft blood vessels to the recipient's blood vessels under a microscope to restore blood circulation before connecting nerves and other tissue, such as bone, cartilage, and muscles.
Conventional reconstruction methods, which are always considered first, do not tend to provide optimal results for patients with extensive facial or limb deformities. Restorative surgery, however, has the potential to deliver these desired functional and aesthetic benefits.
Conventional reconstruction typically involves autologous (self) donation – taking tissue from one or more parts of a patient’s body and transplanting it to another part of that same patient’s body. This typically involves transplanting many tissue grafts, and, thus, many operations and significant scarring. Aside from the trauma of multiple surgeries and the uneven look produced by multiple grafts, there are limits to the functional restoration that conventional reconstruction can produce. This is largely due to the difficulty of trying to restore the function of one body part with the tissue of another body part that has a different structure and function.
Restorative surgery, on the other hand, occurs during a single operation and involves transplanting tissue from one person (the donor) to another (the recipient). The donated tissue is the same type of tissue that is being replaced on the recipient (e.g., donor hand to recipient hand or donor face to recipient face), and, thus, has the same form and function. This tissue matching makes it ideal for restoring a natural look and function.
Functionally, face transplant surgery has demonstrated the ability to immediately restore a patient’s ability to breathe through the nose and speak intelligibly. With time, the ability to smile and show other emotions should also return. Hand transplant surgery can provide a patient with new hands that, after extensive rehabilitation, should allow them to perform daily activities. And the ability to restore a near-normal appearance of the face or hands can lead to tremendous psychological benefits, gradually rebuilding confidence, elevating mood, and encouraging reintegration into society.
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