Dolph Houben

180 CHAPTER 9 Alternatively, one could start experimenting on humans since living bone allotransplantation has the potential for clinical application using our novel method to maintain viability. The technical feasibility of living bone allotransplantation has now been shown in humans and multiple small and large animal models. Additionally, pre-clinical experience with VCA using our novel method is very promising with reproducible results, although found in a low number of experimental cases. Clinical experience with living bone allotransplantation has resulted in one successful transplantation to date [45] . In another case, the recipient of an allogenic vascularized femoral diaphysis was transfected with a cytomegalovirus [39] . Thus, an optimum of hygienic security has to be claimed for recipients of living allogenic bone. Therefore, transplantation protocols, careful case selection, transplantation safety and concerns with immunological hazards should be further evaluated. Prior to clinical application, several human cadaver studies should be conducted to develop transplantation procedures and study the human vascular anatomy of different bones (donor sites). First a review of literature should be performed on the current knowledge on vascular anatomy of different bones and joints. Second, cadaver dissection can be performed by injecting an upper or lower extremity with Microfil (contrast agent which hardens after injection), perform imaging studies (micro-CT), and dissect the limb thereafter. This way multiple expandable donor sites can be investigated. In the future, we expect vascularized composite allotransplantation to be more widely used and accepted. Clinical experience with hand, face and abdominal wall has been the forefront of VCA developments after organ transplantation. With the lessons learned from previous VCA research, and the implementation of our novel method, we provide possible new option for reconstructive surgery. It is essential to acknowledge that reconstructive surgery is not life-saving surgery, therefore the risk to the patient should be minimized. Do no further harm.