Vascularized bone allotransplantation: current state and implications for future reconstructive surgery.

This article focuses on current advances in musculoskeletal tissue allotransplantation, including strategies for maintaining tissue viability in the face of histocompatibility mismatch and resulting acute and chronic rejection responses. In particular, it introduces a novel concept developed in the authors' laboratory and currently under evaluation that may obviate the problem of chronic rejection. The authors have used therapeutic angiogenesis to develop a host-derived neoangiogenic circulation that maintains blood flow regardless of rejection. The replacement of the allogeneic vessels together with bone remodeling from host-derived cells eventually may largely replace the allogeneic osteocytes and bone with native bone.