Lessons learned from simultaneous face and bilateral hand allotransplantation.

1. Biomass from multiple simultaneous allografts has unclear role in higher morbidity witnessed in these procedures to date 2. Multiple allografts may be transplanted in parallel with marginal addition in total operative time 3. Partial hand transplantation is a viable option to preserve residual donor limb function and limit negative sequelae of potential allograft failure 4. Both donor and recipient vascular anatomy appear to be particularly predisposed to thrombus formation 5. Fastidious attention must be paid to nonsurgical management principles during the operative procedure 6. Above all, honor the notion of life over limb • In spring 2011, we performed the world’s second combined face and bilateral hand transplantation, including the world’s first partial hand transplantation. While the procedure was a technical success, the patient became septic several days following the procedure, eventually resulting in compromised circulation to the hands requiring subsequent explantation.