Microsurgery is a technique whereby surgery is performed on very small structures utilizing intra-operative magnification (with an operating microscope), very fine instruments and sutures, and specific techniques. Microsurgery allows for very precise surgery on small objects, which would not be possible with the unaided eye. In the hand and wrist, blood vessels and nerves are commonly no larger than one to two millimeters in diameter (equivalent to the thickness of a pencil lead). By employing contemporary microsurgery techniques, instruments, and the operating room microscope, we can increase the prognosis for successful blood vessel and nerve repairs, as well as digital replantation.

Replantation refers to the surgical reattachment of a completely severed digit, hand, or arm. Replantation has become possible secondary to the development of microsurgical techniques and instrumentation (such as the availability of operating room microscopes). Traditional surgical techniques utilized in conjunction with microsurgery now allows the surgeon to not only reattach severed parts, but also repair those critical structures required for adequate functional recovery. Ideal indications for replantation include the presence of multiple finger amputations, thumb amputations, or amputations involving the hand or forearm, with minimal crush components or other tissue damage. If an amputation occurs, the amputated part(s) should be preserved as best as possible by placing them in a moist wrap in a water-tight plastic bag, then placed in ice to keep cool. Prompt and appropriate evaluation and preparation for replantation is then critical to optimize results and minimize complications. Contraindications for replantation would include situations where the blood supply cannot be established (revascularization), or if the outcome of replantation would be less functional than that of a prostheses or amputation closure.