Background: Proximal hand amputations—those occurring from the metacarpophalangeal (MCP) joint level to the wrist—represent a distinct and challenging subset of replantation cases. These injuries involve large soft tissue masses, multiple critical structures, and significant ischemia burdens. This study aims to analyze predictors of survival in proximal hand replantation based on a single-center experience. Methods: A retrospective review was conducted of all patients who underwent replantation for complete traumatic hand amputation at or proximal to the MCP joint and distal to or at the wrist joint between January 2023 and December 2025. Data collected included mechanism of injury, ischemia times, number of venous anastomoses, use of vein grafts, and patient factors. The primary outcome was replant survival at three months postoperatively. Results: Eight patients (7 males, 1female) with a mean age of 34.50 years (range, 19–52 years) were included. Amputation levels included transmetacarpal (n=3),MCP joint disarticulation (n=2), and transcarpal/wrist level (n=3). The overall survival rate was 87.5% (7 of 8 replants). One replant was lost due to irreversible venous congestion. Analysis revealed that warm ischemia time exceeding 4 hours, crush/avulsion mechanism. All surviving replants achieved functional recovery with protective sensation and meaningful grip strength. Conclusion: Proximal hand replantation can achieve high survival rates when patient selection is optimized. Critical predictors of success include short warm ischemia time, a guillotine-type mechanism, and robust venous outflow reconstruction. Despite the complexity of these injuries, successful replantation offers superior functional outcomes compared to prosthetic alternatives.