Objective. To describe the role of imaging in vascular composite allotransplantation based on one institution’s experience with upper extremity allotransplant patients. Methods. The institutional review board approved this review of HIPAA-compliant patient data without the need for individual consent. A retrospective review was performed of imaging from 2008 to 2011 on individuals undergoing upper extremity transplantation. This demonstrated that, of the 19 patients initially considered, 5 patients with a mean age of 37 underwent transplantation. Reports were correlated clinically to delineate which preoperative factors lead to patient selection versus disqualification and what concerns dictated postoperative imaging. Findings were subdivided into musculoskeletal and vascular imaging criterion. Results. Within the screening phase, musculoskeletal exclusion criterion included severe shoulder arthropathy, poor native bone integrity, and marked muscular atrophy. Vascular exclusion criterion included loss of sufficient arterial or venous supply and significant distortion of the native vascular architecture. Postoperative imaging was used to document healing and hardware integrity. Postsurgical angiography and ultrasound were used to monitor for endothelial proliferation or thrombosis as signs of rejection and vascular complication. Conclusion. Multimodality imaging is an integral component of vascular composite allotransplantation surgical planning and surveillance to maximize returning form and functionality while minimizing possible complications. 1. Introduction Vascularized Composite Allotransplantation, or VCA, refers to the transfer and integration of multiple tissue components and has generally been used to describe nonorgan transplants such as face and extremity [1]. The goal of such procedures is to restore both form and functionality following catastrophic injury. The first such procedure was performed by Peacock in the form of an “en bloc digital flexor mechanism transplant” in 1957 [2–4]. However, the successful investigation into complete extremity transplantation occurred only after the introduction of cyclosporine in 1982, paving the way for the first successful unilateral hand transplant which occurred in Lyon France in September 1998 [4, 5]. Since then, there have been 22 unilateral and 23 bilateral hand transplants recordedby the International Registry of Hand and Composite Tissue Transplantation [6, 7]. Although VCA includes a range of surgical procedures such as face and extremity transplantation, this paper focuses primarily on our
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