Replantation is firmly established as a viable treatment option in many accidental amputations involving the upper extremity. The clinical foundation was laid more than 100 years ago and it is a technique which is now available world wide. The success rate of replantation exceeds 80 per cent. More often than not, appropriately selected patients obtain a functional result which is better than currently available prosthetic devices. The experience gained from small vessel surgery in replantations has aided in the development of reconstructive procedures, including free composite tissue transfers such as toe-to-hand transfers and free flaps.