The Role of Hand Allotransplantion when Bionic Reconstruction is Possible

Bionic prostheses and vascularized composite allotransplantation represent transformative strategies for upper extremity reconstruction. While both approaches aim to restore function and improve quality of life, they differ significantly in technique, risk profile, resource requirements, and long-term outcomes. This review synthesizes current evidence and expert perspectives on the role of hand allotransplantation in the modern era, particularly considering the expanding capabilities of advanced bionic reconstruction. We explore clinical indications, contraindications, functional and psychosocial outcomes, economic considerations, and ethical implications to support patient-centered decision-making in upper limb reconstruction.