PURPOSE Hand transplantation is challenging, especially with respect to postoperative care. Serious complications including rejection of the transplant are possible. To date, imaging has relied mainly on plain radiography, CT and MRI. High-resolution ultrasound (HRUS) has the potential to be a quick, cost-effective and dynamic alternative at least for the initial assessment of most of these complications. We report on our experience with HRUS in three patients after bilateral hand/forearm transplantation. MATERIALS AND METHODS Three male patients with bilateral hand/forearm transplantation after traumatic amputation underwent periodic HRUS and color Doppler assessment. These exams focused especially on the detection of changes at the coaptation sites (nerve/muscle/tendon coaptation) and expected changes in vessels and healing bones in the compound allograft. The HRUS data were compared to available data of other radiological imaging modalities. RESULTS Relevant post-transplant changes such as neuromas, arteriovenous fistulas, heterotopic ossifications and scars were specified by HRUS. In addition information on muscle and tendon function was gained by dynamic ultrasound. In most cases no relevant information gain by other modalities was stated. CONCLUSION Based on our experience, we recommend sonography as a first-line modality for the follow-up of patients who underwent composite tissue allografting. HRUS allows the reliable and timely diagnosis of relevant complications and the monitoring of postoperative changes and sets the course for therapy or further more invasive imaging.