▶ Trauma is the most common reason for amputation of the upper extremity. ▶ The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. ▶ Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. ▶ Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. ▶ Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allo-transplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.