Revision amputation, ray amputation and narrowing of the hand can be indicated for pathological alterations of fingers and thumbs due to traumatic, inflammatory or vascular causes but also for functional deficits regarding mobility, sensibility, perfusion, and/or pain. Surgical amputation is considered if reconstructive options are no longer possible, not desired and are no longer meaningful with respect to effort and risks. Patients need to be informed about the expected deficits in function and esthetic appearance due to the amputation in advance. On the other hand, surgical amputations represent a good treatment option, for which the duration of treatment and scope are well estimated. Therefore, they are good options for patients with comorbidities, with concerns about extensive reconstructive surgery and with limited compliance. It is essential to respect anatomical and functional aspects to guarantee favorable surgical results and avoid complications, which might compromise the function of the hand beyond that which is unavoidable. The most frequent complications after creating a stump or ray resection are persistent pain, unstable skin and soft tissue conditions, mobility disorders, disturbing stumps without function, uncontrolled growth of nail remnants and recurrent inflammation.