Vascularized composite allotransplantation, also known as "Reconstructive Transplantation" is becoming more commonplace worldwide. Hand and upper extremity transplantation make up the majority of clinical vascularized composite allotransplantation cases performed so far. As success with reconstructive transplantation becomes more common, more challenging examples of limb loss are being addressed, including above-elbow, or "supracondylar" upper extremity transplants. Although very few of these cases have been performed worldwide, the authors' experience includes the only 2 cases performed in the United States at the time of this report. This article will discuss indications, challenges, surgical technique, expected outcomes, and alternative technologies for treatment of limb loss above the elbow.