The reattachment of completely severed parts has only been a clinical reality for 40 years. During that time there has been a shift in focus from refining technical aspects and improving success rates to assessing functional outcomes and better defining the indications for replantation. Although replantations are most frequently performed in academic environments, all practitioners should understand the basic indications for replantation as well as the principles of preservation of tissue. The advances in microsurgery and replantation over the past four decades have revolutionized the way reconstructive surgeons restore form and function to the body, and have laid the groundwork for new advances in composite tissue allotransplantation and tissue engineering.