Microvascular replantation at the distal phalangeal level has recently been reported by several authors, but as yet the rate of success has not been constant owing to the technical difficulties associated with small vessels. To solve this problem, over the last 4 years we have used arteriovenous anastomosis to reestablish either the arterial system or the venous drainage system in the 33 digits of our 23 patients. The results have been excellent, with a 91 percent success rate. Such results for replantation of the distal phalanx may be maintained and improved if a small venous graft with several branches is also utilized.