The bases of vascularised composite tissue allotransplantation rely on general principles of plastic and reconstructive surgery and on modern reconstructive microsurgery. In traditional autotransplantation, soft tissues in the form of flaps or vascularised anatomical parts are autotransplanted to another part of the same patient in order to reconstruct a defect caused by trauma, burns, atrophy or tumour ablation. Nonvascularised grafts survive by diffusion of nutrients until a new capillary network is created. In contrast, flaps do survive by a complete autonomous vascularisation created by microanastomosis between donor and recipient vessels (Fig. 5.1). For years, these types of flaps have been used in reconstructive surgery, especially for head and neck reconstruction, breast reconstruction and lower limb salvage. An important clinical and experimental research has been implemented during the past two decades to provide evidence of the vascularisation of soft tissues (Table 5.1) and to develop new types of flaps (Figs. 5.2 and 5.3) to form and develop modern plastic reconstructive surgery.

Survival of microvascular flaps depends on an adequate inflow and outflow of vascularisation. It is not only a question of a correct and efficient microvascular anastomosis and good recreation of an anatomical vascular network, but also of a sufficient and balanced blood flow through the entire transplanted tissues. Similarly, functional and sensory recovery relies on neurotisation of muscle units and excellency on neurorrhaphies between donor and recipient nerves that allow scarless neural union that promotes ingrown of axons into the transplanted nerves (Fig. 5.4). The same general principles do apply to face allografts, which depend on a correct vascularisation and functional recovery from different vascular and neural anastomosis between the graft vessels and nerves and recipient vessels and nerves in the cervical and face areas of the recipient. The basis for a robust flap and efficient surgical technique resides on proficiency in reconstructive surgery and anatomic knowledge, often gained in the anatomy room and experimental microvascular lab.