The last years have registered an important activity in the specialty of plastic and reconstructive surgery. In particular, a real revolution in reconstruction has occurred. The not-so-old dream of restorative surgery, namely, the replacement of damaged parts of the body by new unharmed preformed tissues, has become a reality. The development of techniques aimed at transplantation of vascularised composite tissues (VCA, vascularised composite allografts) has provided clinicians with a new robust tool for the reconstruction of deformities that were, not so long ago, impossible to achieve. History, development and classical attempts for VCA are not a new one. More than four decades ago, doctors in Ecuador attempted the transplantation of a hand limb. The transplant failed, but the dream survived. Pioneering laboratory work in experimental animals showed the path to clinicians for the achievement of human VCA. The works of Dr. Siemionow and Dr. Butler are milestones of the development of this discipline. They showed how tissues could survive after transplantation and implemented the basis for the surgical technique in the clinical scenario. More than ever, this is a perfect example of translational research and implementation of bench work to the bedside. Not so long ago, Dr. Pribaz et al. at Harvard and Brigham and Women’s Hospital illuminated the plastic surgery community with the revolutionary concepts of flap prelamination and prefabrication. These elaborated techniques, well documented in literature, pursue the goal of fabricating new flaps and parts in the human body ready for autotransplantation. There is no surprise that few years later the same institution is at the forefront of face VCA in the USA. On the other hand, VCA has opened a new era not only in reconstructive surgery but also in transplant surgery. To date, there have been reports of successful transplantations of the knee joint, hand (unilateral and bilateral), arms (unilateral and bilateral), face (partial and total), abdominal wall, larynx, penis, digits and lower limbs. All recipients presented with deformities and/or amputations that were not amenable to be reconstructed by means of classical or traditional techniques. Such deformities affected nonvital parts and/or organs, and all of them had in common the impossibility to restore form, function and cosmesis by means of conventional techniques and reconstructive surgery. The results of face transplantation in humans demonstrate that face transplantation is no longer an abstraction but a clinical reality. It has been implemented in the latest years with increasing interest and great success. The limits of indications are still, though, desperate catastrophic face disfigurement. Today, we are in a position to say that it has been possible to perform face transplantation both in animals and humans in a short period of time.

Similarly to that learnt in many other transplant and plastic surgery disciplines, the development of face transplantation programs calls for a strong team approach, building a multidisciplinary team that involves all necessary and diverse specialists to make a robust protocol and an experienced team that warrants excellency in outcomes. This multidisciplinary team is formed by all transplant disciplines usually involved in transplant medicine (surgeons, immunologists, infectious disease specialists, renal disease specialists) but should include also experienced health professionals more involved in the plastic and reconstructive scenario, namely, rehabilitation specialists, physiotherapists, occupational therapists, psychologists, psychiatrists and social workers. VCA procedures must be organised in tertiary centres with a strong commitment to transplant surgery and medicine. Such institutions have in common the required laboratory, clinical services and research units that are necessary to perform this new clinical discipline.

The general objective of our intense efforts in basic, clinical research and implementation in the human clinic is the standardisation and introduction of a new treatment for patients suffering from severe face deformities and destructions caused by burns, trauma, congenital defects and the extirpation of malignant tumours. It introduces technical aspects, immunological, psychological, ethical and legal methodologies and the necessary surgical proficiency for the performance of face transplantation.