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Vascularised composite allotransplantation (VCA) is utilised for restoration of complex defects. In this context, restoration describes the replacement of destroyed tissue by identical anatomic structures. Up to date, over 150 VCAs including 31 face transplantations have been performed worldwide. Face transplantation is a life giving, rather than life saving procedure that is intended to significantly improve the patient's quality of life. Safe revascularisation as well as aesthetic and functional reintegration are the ultimate goals of face transplantation. The necessary lifelong immunosuppression with potentially life-threatening side effects imposes the need for a very strict risk-benefit ratio assessment and currently limits the indications of face transplantation. Different transplant centres use different protocols for induction and maintenance immunosuppression. Skin is the most immunogenic part of the vascularised composite allograft and has been the focus of intensive research efforts in order to replicate the success of immunosuppressive regimens for solid organ transplantation. Organ preservation during transfer from donor to recipient is another important field of research within VCA. The general public's originally rejecting attitude towards non-lifesaving VCA procedures has changed towards a general acceptance following the publication of promising results after the first cases of face transplantation. Further improvements of surgical techniques and immunosuppressive strategies will be important to drive these young and exciting procedures forward in the future., (© Georg Thieme Verlag KG Stuttgart · New York.)

This is a report of a long-term study at the Friedrich-Alexander University of Erlangen-Nurnberg, Germany from 1936 to 1994. We divided tumors into three categories, i.e. skin, soft tissue and bone tumors. 4612 tumors were included in the study. Over the course of the study, a dramatic change in the occurrence of single tumors was noticed. While tumor-like lesions have been on the decline, other types of tumors, especially malignant tumors as well as more advanced stages of tumors have become a common occurrence. We will show that particularly larger institutions experience an ever increasing number of advanced tumors requiring individual approaches.

The revised survey involves the years 1991 and 1992 and includes 41 university and major civil hospitals. As in the years 1989 and 1990, replantation activity in the year 1991 still declined, whereas in 1992 we registered a sharp increase in replantations, especially in Germany. In numbers, 856 were reported for 1991 (72 macro- and 784 microreplantations), and 1091 in 1992 (85 macro- and 1006 microreplantations). A considerable number of amputation cases (617) were rejected mainly due to lack of operative manpower capacity.

This survey concerns the years 1989 and 1990. While the number of institutions performing replantations remained constant in Austria and Switzerland, there has been a noticeable trend in Germany from around-the-clock replantation centers to simple replantation services, offering emergency microsurgery by arrangement only. The total number of replantations performed decreased from 975 replanted parts (903 microreplantations and 72 macroreplantations) in 1989 to 875 in 1990, with a micro-/macroreplantation ratio of 12.8:1. Based on the results of questionaire received from 34 university and city hospitals in Austria, Switzerland and former West Germany, an analysis of clinical organization and management of replantation services is presented.