Replantation in the mutilated hand

Since the first replantation 40 years ago, refinements in technique and advances in technology have enhanced survival rates and functional outcomes. The decision to attempt replantation and the techniques involved in replantation of amputated parts are often extremely difficult. The best survival and functional rates for replantation of amputated upper extremity parts are achieved with sharp amputations of the thumb, multiple fingers or at the level of the hand and wrist in younger patients. Preoperatively the patient must be prepared psychologically, to provide for realistic expectation for survival and return of function of the replanted part. Intraoperatively application of specialized techniques and optimal order for repairing of the various injured structures can improve operative times and survival rates. Post-replantation procedures such as tenolysis can be considered to optimize final outcome. Forty years after the first replant we recognize the ultimate goal not merely to preserve all living tissue through nonselective replantation but rather to preserve one's quality of life by improving their function and appearance.