In a
first-of-its-kind procedure, doctors in the United States have successfully
transplanted a “composite” skull and scalp flap, along with kidney and pancreas
– all from the same donor – in a 55 year old patient. The patient was suffering
from a non-healing scalp defect and declining organ kidney and pancreas
function. Hopefully, this case and others like it will help to widen the narrow
indications for this fascinating new field of reconstructive surgery.
The experience
may open the way to further procedures combining “vascularised composite
allotransplantation” (VCA) with organ transplants, in patients who have already
accepted the need for lifelong immunosuppressive therapy. VCA refers to
transplant procedures combining different type of tissues, such as skin,
muscle, blood vessels, nerves and bone.
However,
they have a major drawback – the need for immunosuppressive drugs to prevent
the recipient’s immune system from rejecting the transplant. Two decade
earlier, the 55 year old patient had undergone kidney transplantation for
diabetic kidney disease, but that kidney was now failing.
He also
had a large, unstable wound of the scalp and skull – a complication of surgery
and radiation therapy for a scalp tumour. Since the patient was already
receiving immunosuppressive therapy and would need another organ transplant in
any case, doctors suggested a procedure in which a VCA of scalp and skull would
be performed at the same time as a kidney/pancreas transplant, all coming from
the same door.