Abstract
Introduction
The first vascular composite allotransplantation (VCA) was performed in 1998, with the first post-burn VCA in 2003. Since then, 21 burn patients have been recipients of VCAs. Controversy exists regarding safety of VCA in burn patients due to high levels of immunologic sensitization attributed to use of cadaver allograft. We seek to understand unique considerations of VCA in burn reconstruction and its relative safety compared to VCA in non-burn reconstruction.
Methods
A systematic review of VCA in burn reconstruction was conducted using the PubMed, Media and EBSCO database to retrieve all articles and news stories studying VCA from Jan. 2000 to May 2019. Only articles containing composite tissue allotransplantation, VCA, and reconstructive surgery were included. Articles that did not report outcomes or patient information were excluded. Reported cases were grouped according to injury and tissue (face vs. upper extremity) with mortality as a dependent variable. Statistical analysis was performed with the Fisher exact test.
Results
Of 63 articles obtained, 21 met criteria. After secondary review by the senior author, 6 more articles were included. To date, 147 VCAs are reported in 112 patients, including 40 face VCAs and 107 upper extremity VCAs. Of these, 30 (20%) were performed for post-burn deformities, and 117 (80%) for non-burn deformities. A total of 21 post-burn patients received VCAs with 4 subsequent deaths (19%). Post-burn recipients of upper extremity VCAs had significantly higher mortality than non-burn recipients of the same (p = 0.01), but there was no significant difference in face VCA mortality (p = 1.0) or overall mortality (p = 0.06) between groups.
Conclusions
VCA is a forefront procedure employed worldwide for reconstruction of devastating injuries. Presently, burn patients are at greater risk of mortality after upper extremity VCA, but not face VCA. Burn patients will benefit from focused investigation of unique post-burn risk factors of VCA mortality.
Applicability of Research to Practice
Disparities between post-burn and non-burn VCA outcomes suggest the presence of unique risk factors in burn patients. Investigation of unique risk factors will improve safety of VCA for burn patients.
A meta‐analysis evaluating risk factors for compound free flaps for upper extremity defect reconstruction comparing complications and functional outcomes of compound free flaps with and without bone components
