Experimental and clinical experience with small composite tissue allotransplants and cryopreservation techniques

Reconstruction surgery requires imagination, inventiveness, and creation-a quest that entails overcoming obstacles never before encountered. Over the past 25 years, with the advent in microsurgery of free revascularized transfers, it was believed that this fundamental breakthrough would be sufficient to resolve difficulties of whatever nature, and that little else would be necessary. Undoubtedly, the results obtained by using free autotransfers have been so remarkable that it is no longer possible to undertake reconstruction in plastic surgery without fully mastering these techniques. Nevertheless, limitations remain, especially with regard to form and shape, as there are areas where form and function merge. As a result, some clinical cases today continue to induce a sense of powerlessness, as was the case 25 years ago when surgeons were presented with large skin defects that are nowadays treated routinely and with a sense of confidence. The sense of powerlessness today clearly signals that another milepost needs to be reached; we believe this milepost should be allotransplantation. Yet allotransplantation should not remain within the realm of the exceptional; on the contrary, it should become routinely accessible. But in order for it to become so, cryopreservation, a pathway that has so far received little attention, and about which much remains to be learned, should be explored. Accordingly, in this article, we report our experience with xenotransplantation, a mainly clinical procedure in the area of hand surgery.