#### Summary points Traumatic hand or digit amputations can be catastrophic injuries, and often occur in young productive patients.1 2 3 Figures from the US national database have shown that amputation injuries represent 1% of all trauma attendances. Finger and thumb amputations were most common (69%), and more proximal amputations of the upper limb contributed a further 9%.3 Most patients with amputations are initially managed by non-specialists, before referral to microsurgical units. Good initial management is a key determinant of outcome, and expertise in the management of amputation is only available in specialist centres in most countries.4 We provide a summary of the initial management of amputation, with emphasis on amputate preservation, indications for replantation (reattachment surgery), and potential outcomes, to help non-specialists manage these emergencies and refer them appropriately. #### Sources and selection criteria Few large scale, randomised controlled trials have looked at upper extremity amputation. Data mostly come from multiple case series, case reports, or small trials. We have combined our knowledge with that published in articles identified by PubMed searches, using the terms “amputation” and “replantation” and selecting English language articles relevant to upper extremity replantation. ### Assessment of patient Patients are assessed according to the Advanced Trauma Life Support (ATLS) protocol, and resuscitated as necessary.4 5 6 Multiple amputation is an independent risk factor for death.3 If bleeding vessels are clamped …