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–recipient matching, better understanding of ischemia–reperfusion 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.

Background: Psychosis may be conceptualized as a spectrum disorder, with psychotic experiences (PEs), fleeting, subtle symptoms not warranting clinical presentation—at its mildest end. The thalamus, particularly its pulvinar region, is implicated in coordinating cortical synchrony and attention, and may contribute to psychosis. Reduced pulvinar volumes have been observed in severe psychosis and in individuals lower on the spectrum. This study examines thalamic nuclei changes in young adolescents with PEs. Methods: A community-based sample of 95 adolescents aged 11-13 years (53 with PEs, 42 healthy controls) underwent magnetic resonance imaging (MRI), with thalamic nuclei volumes calculated using Freesurfer. Magnetic resonance imaging (MRI) was repeated at 2- and 5-year follow-up. Analyses of covariance and linear mixed-effects (LME) models assessed group-wise differences at each timepoint (TP) and longitudinally. Individual nuclei were recombined into anatomical composites (eg, pulvinar, ventral) for targeted analysis. Results: Compared with controls, adolescents with PEs had significantly smaller left pulvinar composite volumes at TP2 (P = .01) and TP3 (P = .019). Linear mixed-effects revealed a significant longitudinal reduction in left pulvinar volume (P = .008, false discovery rate [FDR]-corrected) and a significant increase in left ventral volumes (P = .013, FDR-corrected). Conclusions: Thalamic changes linked to higher-risk psychotic states appear detectable in nonclinical adolescents with subthreshold PEs. This divergence from normative developmental trajectories may indicate early alterations in neural circuits governing attention, cortical synchrony, and dopaminergic function. Identifying such early deviations could refine our understanding of psychosis vulnerability. Replication in larger, more diverse cohorts is warranted to confirm these preliminary findings and assess their predictive value.

This case presents a 35-year-old male with spinal predominant neurofibromatosis-1 who developed an incomplete spinal cord injury (C3 Asia C) which did not improve despite urgent decompressive surgery for multiple cervical neurofibromas. This report outlines a novel indication for intrathecal baclofen. The patient suffered from lower limb weakness with severe spasticity and required assistance of at least two for all activities. The aim of rehabilitation was to improve overall tone while focusing on independence, mobility and quality of life. After a successful trial of intrathecal baclofen, he underwent implantation of an intrathecal baclofen pump. The dose was gradually increased while he received a progressive programme of stretching and functional rehabilitation therapy. After 6 weeks, his MAS had improved to 1–2/4 and he had progressed to independent transfers, independence for most activities of daily living and was able to discharge to his family home with minimal support.