© 2008 Springer Science+Business Media, LLC. All rights reserved. Patients suffering from severe tissue loss secondary to burns, traumatic injuries, or tumor resections have limited options for reconstruction when autologous tissue for reconstruction is scarce. Composite tissue allotransplantation (CTA) has recently been introduced as a potential clinical treatment for functionally significant tissue loss. CTA has emerged as an amalgamation of advanced microsurgical techniques for limb and flap autotransplantation, and improved immunosuppressive agents to prevent rejection. However, as a developing field, it is yet to have its unique immunological properties established.