Document Detail


Invited Review: Perioperative risk factors for vascularized composite allotransplantation: A systematic review and proposal of identity-defining VCA.
MedLine Citation:
PMID:  23836513     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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, 2013.
Authors:
Hainan Zhu; Xian Wei; William Lineaweaver; Qingfeng Li
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-9
Journal Detail:
Title:  Microsurgery     Volume:  -     ISSN:  1098-2752     ISO Abbreviation:  Microsurgery     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309230     Medline TA:  Microsurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Wiley Periodicals, Inc.
Affiliation:
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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