Vascularized Composite Allotransplantation (VCA) is the transplantation of tissues such as skin, muscle, nerves, and blood vessels from a donor to the recipient. This type of reconstructive transplantation is a viable treatment option for patients with defects that involve several different functional tissues. The two most common examples of VCA are facial transplantation (FT) and hand transplantation (HT). This chapter will discuss the historical perspective, epidemiology, surgical techniques, perioperative management, and immunology of FT and HT.