Together Everyone Achieves More: A Team-based Analysis of the First Successful Face and Bilateral Hand Transplant

Teamwork and communication are critical to reducing medical error, particularly in complex surgical procedures such as vascularized composite allotransplantation (VCA). Although cadaveric rehearsals are used to prepare for VCA, their effect on team development and operative outcomes remains unstudied. We therefore sought to evaluate the evolution of teamwork and its impact on operative outcomes in preparation for the first successful combined full-face and bilateral hand transplant.

Cadaveric rehearsals were conducted in preparation for a combined full-face and bilateral hand transplant. As a quality improvement effort, teams followed surgical checklists and were assessed for teamwork using the Clinical Teamwork Scale (CTS) and the Oxford Non-Technical Skills (NOTECHS) tool. Face- and hand-specific scores and dissection times were recorded at each rehearsal to guide debriefings and refine subsequent sessions until transplantation.

Eleven cadaveric rehearsals were conducted with 9 surgical teams, each including at least 3 surgeons, 2 nurses, and 1 research fellow. Overall mean CTS scores improved significantly from baseline to transplantation for both face and hand teams, with notable gains in teamwork, communication, situational awareness, and decision-making. Linear regression showed significant positive associations between rehearsal number and scores in most CTS and NOTECHS domains. Total dissection time significantly decreased from 411 minutes at baseline to 273 minutes at the final rehearsal (P = 0.004).

Teamwork and dissection time significantly improved during 11 cadaveric rehearsals, culminating in the first successful face and bilateral hand transplant. A comprehensive, team-based approach is essential to the success of VCA.