{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:44:47Z","timestamp":1791834287705,"version":"4.3.4"},"reference-count":123,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012921","name":"Royal College of Surgeons in Ireland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012921","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010414","name":"Health Research Board, Ireland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Vascularised composite allotransplantation (VCA) has an evolving role in the reconstruction of complex functional and aesthetic deficits non-amenable to autologous or implant-based reconstructive modalities. International applications of VCA span upper extremity, face, abdominal wall, uterus, and penile transplantation, with more than 300 procedures performed worldwide. Among these, abdominal wall transplantation has uniquely contributed to the development of the sentinel skin flap (SSF) concept, in which solid organ transplant patients undergo simultaneous transplantation of a solid organ and a donor-derived vascularised skin flap, with the skin component of the SSF being trialled internationally as a means of monitoring for rejection within the solid organ allograft. Despite growing clinical success, VCA continues to face substantial barriers to wider adoption. Acute rejection remains highly prevalent, affecting up to 89% of recipients, with significant morbidity linked to intensive systemic immunosuppression. Challenges are further amplified by the unique immunological heterogeneity of composite grafts, ethical concerns surrounding identity-linked tissues, and the lack of standardised outcomes reporting across VCA subtypes. Advances in machine perfusion technologies and emerging cellular and biomaterial-based immunomodulation strategies show promise in reducing immunosuppression burden and improving graft longevity. This review outlines the current state of VCA, including clinical applications, outcomes, and mechanistic insights from pre-clinical studies, while highlighting key ethical considerations and evolving regulatory frameworks. Future progress will depend on standardised reporting systems, improved donor\u2013recipient matching, better understanding of ischemia\u2013reperfusion injury, and the development of next-generation immunosuppressive\/immuno-modulatory therapies. Collectively, these innovations position VCA as a rapidly advancing field with significant potential to redefine reconstructive and transplant surgery.<\/jats:p>","DOI":"10.3390\/medicina62020245","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T17:52:38Z","timestamp":1769190758000},"page":"245","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Vascularised Composite Allotransplantation: Emerging Applications in Reconstructive Surgery and Solid Organ Transplantation"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8437-1447","authenticated-orcid":false,"given":"Cian M.","family":"Hehir","sequence":"first","affiliation":[{"name":"Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland, 123 St. Stephen\u2019s Green, D02 YN77 Dublin, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons, 123 St. Stephen\u2019s Green, D02 YN77 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal College of Surgeons, 123 St. Stephen\u2019s Green, D02 YN77 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia","family":"Marinescu","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, St. Vincent\u2019s University Hospital, Elm Park, D04 T6F4 Dublin, Ireland"},{"name":"UCD School of Medicine & Medical Sciences, University College Dublin, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fungai","family":"Dengu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary & Transplant Surgery, St. Vincent\u2019s University Hospital, Elm Park, D04 T6F4 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2017-5193","authenticated-orcid":false,"given":"Henk P.","family":"Giele","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford OX3 9DU, UK"},{"name":"Oxford Research in Plastic Surgery and Hand Surgery Innovation Collaboration (ORPHIC), Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roisin T.","family":"Dolan","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, St. Vincent\u2019s University Hospital, Elm Park, D04 T6F4 Dublin, Ireland"},{"name":"UCD School of Medicine & Medical Sciences, University College Dublin, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.bjps.2013.06.037","article-title":"Vascularized composite allotransplantation: An update on medical and surgical progress and remaining challenges","volume":"66","author":"Murphy","year":"2013","journal-title":"J. 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