Arm transplantation: prospects and visions

Based on the results of above-elbow replantation, it is possible that above-elbow arm transplantation will be successful and result in a superior functional outcome as defined by the Chen criteria. Above-elbow arm transplantation is probably technically simpler than distal forearm or wrist transplantation, especially since the macroanastomoses do not require microsurgical expertise. However, hand function depends on reinnervation of forearm muscles and the distance for nerves to regenerate for reinnervation of intrinsic muscles of the hand is significant. The vascularized bone marrow transplanted with the arm holds potential to induce chimerism and promote tolerance but could also make the recipient more susceptible to graft-versus-host disease. Prospective trials comparing the functional results after above-elbow arm transplantation with the functional results achieved by the best neuronal-controlled above-elbow prosthesis are warranted and will determine the gold standard of upper-extremity reconstruction.