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(3) Successful replantation relies on a team of people that work in concert. From the operating theatre,
to the hospital ward, the therapists’ suite, and the doctor’s office-all members of the team must be
knowledgeable, dedicated, and skilled at treating this unique patient population. Only with this team in
place should replantation be embarked. The surgery is only one component of the patient’s care.

(4) Replantation surgery is a unique surgical procedure and involves the treatment of multiple different
tissue structures: osseous, nerve, skin, vasculature, and connective tissue. Survival of the digit focuses
primarily on only one tissue structure - the vasculature. However, successful replantation, as discussed
above, must include consideration of function. For this reason, equal attention must be placed on treating
all tissue structures. When one tissue structure is either prioritized or neglected compared to the others,
the function will suffer.

The future of replantation surgery is at a crossroads. If current trends in the United States remain,
successful replantation will become an uncommon occurrence with ever increasing contraindications. As
the advancements in partial hand and finger prosthetics have accelerated, some may begin to argue that
digit replantation is never necessary. Whether or not the technology will ever develop to the point of being
equal to a native and well-functioning digit is uncertain and debatable. Irrespective, technology is far from
that point yet and our patients are still in need of successful replantation surgery. Especially in the United
States, we must acknowledge that the state of replantation surgery has regressed and is inferior to some of
our colleagues around the world. The field of hand surgery and our patients require that we not accept the
current state. We must make the necessary changes to further the current standard.

DECLARATIONS
Authors’ contributions
Made substantial contributions to review of literature, writing of article: Noh K, Hacquebord JH

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Rui P, Kang K. National hospital ambulatory medical care survey: 2017 emergency department summary tables. National Center for
Health Statistics. Available from: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdg. [Last accessed on 10
Sep 2020]
2. Cho HE, Zhong L, Kotsis SV, Chung KC. Finger replantation optimization study (FRONT): update on national trends. J Hand Surg Am