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Composite tissue allograft transplantation is a recognized option for reconstruction in upper limb amputees. Sirolimus is an immunosuppressive drug that prevents organ rejection and improves kidney function, but its use has been associated with impaired healing. Two recipients of bilateral hand allografts underwent arthrodeses of 6 joints as secondary procedures while being treated with sirolimus. We found no clinical or radiologic evidence of bone healing delay or bone nonunion. The functional evaluation revealed an improvement in the performance of activities of daily living after the transplant and secondary procedures. We conclude that bone surgery can be performed safely in recipients of hand allografts who are receiving sirolimus-based immunosuppressive therapy.