Is Vascularized Composite Allotransplantation a Suitable Reconstructive Option for Extensive Defects in Burned Patients? Clinical and Immunological Evaluation Protocol.

Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome in patients with extensive defects, involving multiple layers of functional tissue, often necessitating numerous, and staged, surgical interventions with unsatisfactory results. Transplantation of vascularized composite allografts(VCA) opened a new, promising era in reconstructive surgery, offering a unique restorative opportunity for those complex situations. VCA transplantation have been performed for life enhancing indications in a selected group of patients under institutional protocols. The controversy of those procedures, having functional benefits and the goal of quality of life restoration, rather than life-saving indications, resides to the life-long required immunosuppressive therapy, with implicit side effects. In order to extend VCA indications, translational studies are needed to develop less toxic immunosuppressive regimens and possibly achieve donor-specific tolerance, the ideal situation in transplantation. Extensively burned patients, especially of the face and cervical region, having severe mutilations and also unilateral or bilateral hand amputations, like after high voltage electric injuries, present functional and aesthetic deficits, with devastating impact on their quality of life and, constituting potential candidates for receiving a vascularized composite allotransplantation, as the only reconstructive solution. With this paper, we discuss the indications and limits, from clinical and immunological perspectives, of the consideration of VCA as surgical option for burn patients with complex tissue defects, impossible to approach by conventional techniques. [ABSTRACT FROM AUTHOR]