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Composite tissue allotransplantation (CTA) now represents a valid therapeutic option after the loss of a hand, forearm or digits and has become a novel therapeutic entity in reconstructive surgery. However, long term high-dose multi-drug immunosuppressive therapy is required to ensure graft survival, bearing the risk of serious side effects which halters broader application. Further progression in this field may depend on better understanding of basic immunology and ischemia reperfusion injury in composite tissue grafts.To date, orthotopic hind limb transplantation in rats has been the preferred rodent model for reconstructive transplantation (RT), however, it is an extremely demanding procedure that requires extraordinary microsurgical skills for reattachment of vasculature, bones, muscles and nerves.We have introduced the vascular cuff anastomosis technique to this model, providing a rapid and reliable approach to rat hind limb transplantation. This technique simplifies and shortens the surgical procedure and enables surgeons with basic microsurgical experience to successfully perform the operation with high survival and low complication rates. The technique seems to be well suited for immunological as well as ischemia reperfusion injury (IRI) studies. For the operative procedure a sterile set of microsurgical instruments is utilized. The surgeon should wear proper attire including sterile gloves, which have to be changed prior to the start of the surgical procedure. 2. The rat is anesthetized with an intraperitoneal injection of pentobarbital (50mg/kg IP) and placed supine on a heated operation field, which facilitates a stable animal body temperature throughout the entire surgical procedure. 3. Prior to skin incision the filed of operation is sanitized three times each with both, a disinfectant and alcohol. To prevent the animal's corneas from drying out, eyes are lubricated with an ophthalmic ointment (Vidisic) prior to surgery. 4. A skin incision is made across the right groin approximately at the level of the inguinal ligament. The femoral vessels are dissected free with bipolar cautery and blunt dissection; deep branches are ligated with 8-0 silk. 5. 300μl (50 IU) of heparin are injected via the penile vein for anti-coagulation. 6. Femoral vessels are ligated at the level of the inguinal ligament and cut distal to the ligature. 7. The hind limb is flushed with ice-cold (4°C) HTK solution (5ml) via the femoral artery over 5 minutes. 8. All muscle groups are sharply divided with scissors and osteotomy is performed with a rotating electrical saw at the level of the distal third of the femur. 9. The harvested limb is then submerged in 20mL of ice-cold HTK solution for preservation and cold storage until transplantation. Protocol Donor Operation and1. The rat is anesthetized with an intraperitoneal injection of pentobarbital and placed supine on the operation field. 2. A skin incision is made across the right groin approximately at the level of the inguinal ligament. The femoral vessels are dissected ...

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