It is evident that the independent experiences of these hand surgery units in three completely different parts of the world are remarkable similar. For the most part, one can readily account for the differences reported on the basis of interpretations of such vague terms of evaluation as "good" or "poor" and on case selection, which is often dictated by local cultural considerations. For example, a hand with some useful prehension placed on an extremely shortened arm may be most welcome to a Chinese patient, whereas a hand attached to the humerus may be looked upon as grotesque in the Western cultures an so be psychologically devastating. Yet, such differences are minor compared with the common pattern of experience that clearly exists and upon which conclusions can be based for formulating some general guidelines. Indications for upper limb reattachments at this time are neither absolute nor static. They are relative, dynamic, and surely will change as experience increases and techniques become even more refined. Success must not be equated with tissue survival but measured only in terms of what the effort has done for the patient in a global sense. As yet, completely satisfactory system for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not change.