The literature on surgical techniques and recent evidence in microsurgical digital and hand replantation is reviewed. Replantation should not be done routinely without considering postoperative functional outcomes. Achieving best outcomes is related to the success of microvascular anastomosis and to adequacy of bone fixation, tendon and nerve repair, and soft-tissue coverage. Replantation surgery has become a routine procedure. However, little is known about the decision-making process for digital and hand amputation. A study comparing the outcomes of digital and hand amputations treated with replantation or revision amputation is needed. Outcome assessment includes not only function but also patient-reported outcomes.