Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organization, Staff Requisites for Hand Transplantation:The Milan Experience

Hand surgeons and reconstructive microsurgeons have been “transplanting” composite tissues for a long time. Every time we perform a free flap, we are actually performing a true transplant. Most of the time there is no choice other than to adapt a flap coming from a certain donor area to a recipient area with different characteristics. Normally this happens in cases of complex multitissue defects or when the tissue that needs reconstruction carries some unique features. So while we are now exploring the area of prefabrication or prelamination of flaps, we are aware that we are far from perfection, hence the need to look at using possible allogeneic tissues [1]. With the advent of microsurgery, the long-term results of autologous replantation of the upper extremity, especially after a clean-cut amputation, have become extremely good. In a recent long-term review study, it was shown that replanted hands and forearms had a mean loss of range of motion of 17.5% [2].