427.3: Military Veterans’ Knowledge, Attitudes, and Interest in VCA Treatment for Disfiguring Service-Related Injuries

Abstract

Background: Thousands of American service members have suffered catastrophic injuries to the head, face, and extremities resulting in functional limitations and significant disfigurement. The rise of vascularized composite allograft (VCA) procedures now allows for hand and face transplants, which can improve the functioning, mobility, and quality of life for these veterans, particularly those who have not responded well to available reconstructive procedures or prosthetics. Despite potentially life-enhancing outcomes, however, the awareness of and interest in this treatment option by VCA-eligible veterans is unknown. By examining this population’s receptivity to VCA, the study’s goal of identifying the assets and barriers to receiving a VCA will instruct more informed decision making about this treatment. Methods: In collaboration with the Veterans Affairs Medical Center (VAMC) in Coatesville, PA, and the Department of Defense Joint Trauma Registry, over 1,100 medical records from 2010-2019 were reviewed for applicable ICD-9 codes. In-depth semi-structured interviews were conducted via telephone or video conference with up to 60 military veterans to examine current health status, treatments and therapies, impact of their injuries on daily life, and reactions to VCA, as the primary domains of inquiry. Interviews were audio-recorded for accuracy, deidentified, and transcribed for analysis. The existing domains and emergent themes formed the basis of a codebook, and MAXQDA software was used to facilitate qualitative coding of the data. Results: Most participants interviewed to date, reported amputation of one or both hands. Although largely unfamiliar with the technical terminology of “Vascularized Composite Allotransplantation,” most expressed familiarity with the procedure when described in more detail. While initial reactions were largely positive, many participants did not see this treatment as necessary for themselves. Multiple participants indicated greater receptivity if they were less adapted to their injury or did not have at least one functioning upper limb. Reported concerns included possible graft rejection, recovery time, medical fatigue, side effects of immunosuppression, and the effectiveness of the VCA procedure. Respondents identified more functional independence as the most critical and desired outcome of receiving a VCA graft in addition to navigating their day-to-day environments with fewer accommodations and adaptive equipment. Conclusion: Participants viewed VCA as an interesting medical advancement and acknowledged its potential benefits but also expressed skepticism about its efficacy. These observations provide a knowledge base for researchers and practitioners engaged in growing the field of VCA. Further examination of the attitudes and experiences of the caregivers and healthcare providers of VCA-eligible patients would offer valuable perspectives in informing decision making about VCA. U.S. Department of Defense, Grant/Award Number: W81XWH-19-1-0274.