Concomitant face and hand transplantation: perfect solution or perfect storm?

Face and hand composite tissue allotransplantations have evolved into a promising subset of reconstructive transplant surgery due to recent advances in immunotherapy. Concomitant composite tissue allotransplantation, which involves a variable combination of facial (myocutaneous versus osteomyocutaneous) and upper extremity (ie, various levels) composite subtypes, has been performed infrequently at this time. In this review, we will describe many reasons as to why this field remains unexplored. Undoubtedly, future investigation is warranted to investigate the potential advantages and disadvantages of using this approach versus a staged manner for alloreconstruction and to identify the complexities of cortical reorganization and rehabilitation in this setting.