Military VCA in the World
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VASCULARIZED COMPOSITE ALLOGRAFTS (V GORANTLA, SECTION EDITOR)
Military VCA in the World C. A. Fries 1
&
D. Tuder 2 & V. S. Gorantla 3 & R. K. Chan 4 & M. R. Davis 5
# Crown 2020
Abstract Purpose of Review The world’s first hand transplant was performed for a serviceman in 1964, following a blast injury. Despite a need for such effective reconstruction of military wounds, only eight further transplants have been performed for injured soldiers. This review analysed the specific factors that have informed the use of vascularized composite allotransplantation (VCA) in military patients. Recent Findings Nine servicemembers have received reconstructive transplants worldwide. Seven have received upper limb transplants, one a partial face transplant and one a penile transplant. These have been in Ecuador, the USA, Poland, India and Russia. Countries with clinical VCA programmes in military hospitals include Vietnam and China, whilst others have active preclinical VCA research programmes including the USA, the UK and Canada. Summary Despite specific concerns in reconstructing military patients using VCA, outcomes have improved in the last decade and the field has evolved to include more complex tissue composites, across more international centres. Keywords Vascularized composite allotransplantation . Hand transplant . Face transplant . VCA . Composite tissue allotransplantation . Military reconstruction . Trauma . Blast injury
Introduction The world’s first hand transplant was performed in Ecuador for a marine who had lost his hand in a grenade blast injury [1]. The immunosuppression regimen of the time did not enable enduring success, and the transplanted hand was lost after 21 days. The so-called modern era of vascularized composite allotransplantation (VCA) was heralded in 1998, when a team in Lyon, led by Prof Dubernard, transplanted a cadaveric hand This article is part of the Topical Collection on Vascularized Composite Allografts * C. A. Fries [email protected] 1
Oxford University Hospitals, Oxford, UK
2
United States Air Force (Reserve) San Antonio, San Antonio, TX, USA
3
Wake Forest School of Medicine, Winston-Salem, NC, USA
4
Plastic and Reconstructive Surgery, Clinical Division and Burn Center, The United States Army Institute of Surgical Research, San Antonio, TX, USA
5
US Combat Casualty Care Research Program, Medical Research and Materiel Command, Washington, DC, USA
to Clint Hallam, achieving a durable result with the use of systemic immunosuppression [2]. A proliferation of worldwide VCA units ensued, and the field expanded to include the transplantation of the face, abdominal wall, neck, scalp, lower limb, penis and uterus [3]. Simultaneously, the Global War on Terror was being waged in the Middle East. As combat casualty care has improved through the ages, the complexity of reconstructive surgery required has increased; combatants have survived, despite ever more severe wounds [4, 5]. Conflict in the trenches of World War One lead to hitherto unseen maxillofacial injuries that revolutio
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