[Reconstructive surgery using composite tissue allografts: perspectives from the first clinical cases]

Tissue allotransplantation is defined by the transfer of tissues harvested from a cadaveric donor (in a brain dead condition) and revascularized to a recipient subject. This is based on the mastery of microsurgical techniques and on the induction of a therapeutic immunosuppression for the recipient. The first allografts (flexor tendon systems, knees and femoral diaphysis, hands, nerves, larynx) opened the field of composite tissue allotransplantation (C.T.A.) in reconstructive surgery. Immunosuppressive agents are now efficient enough to prevent the rejection of the allografts. The first patients operated on did not suffer from major or irreversible complications, but some potential side-effects of the immunosuppression remain an obstacle to the development of allografts in reconstructive surgery. The early functional results of the allografts are encouraging but their long term evolution remains uncertain. Some immunological (the chronic rejection) or psychological (the refusal of the graft and of its constraints) phenomenon might curtail the functional, aesthetic and psychological result. Currently considered as an extreme solution to exceptional indications, C.T.A. represents a tremendous hope for the future of reconstructive surgery.