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Perioperative risk factors for vascularized composite allotransplantation: A systematic review and proposal of identity‐defining VCA
Author(s) -
Zhu Hainan,
Wei Xian,
Lineaweaver William,
Li Qingfeng
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22125
Subject(s) - medicine , allotransplantation , perioperative , transplantation , intensive care medicine , identity (music) , dimension (graph theory) , surgery , general surgery , physics , mathematics , pure mathematics , acoustics
Vascularized composite allotransplantation (VCA) is a new dimension in reconstructive surgery. Generally, these procedures are offered for quality of life and functional indications rather than life‐saving indications. Controversy exists, therefore, over the indications and risk/benefit ratios of VCA. Transplantation failure is a basic measurable risk of VCA. In this report we attempt to analyze perioperative factors associated with failures. Such factors are generally independent of technical performance and can be assessed to better define regulations applied to VCA. Ninety‐one VCA procedures were identified, and 18 (19.8%) of them failed. Significant ( P < 0.05) failure rates were associated with idiosyncratic cases (100%), cases performed without psychological screening (56.3%), cases performed without competent social support systems (44%), and cases done in developing countries (52.4%). A substantial but not significant failure rate was observed in cases performed without institutional review (36.4%). These findings suggest that institutional, professional, social, and ethical standards applied to VCA should require clarification of perioperative risk managements for any clinical VCA program, because such managements can be critical factors in determining outcome. The special character of these transplantation procedures suggest the concept of identity‐defining vascularized composite allotransplantation (IVCA), for which psychological screening and third‐party supervision is recommended. © 2013 Wiley Periodicals, Inc. Microsurgery 34:240–244, 2014.