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A number of factors that influence the success of microvascular anastomosis have been studied, including adventitial stripping, choice of suture material and needles, suturing technique, and perfusion of the distal lumen. It is apparent that only minimal stripping of the adventitia is indicated in order to prevent increased necrosis of the vessel ends at the anastomosis site. The use of 10-0 monofilament nylon suture material with needles 75 microns or less in diameter achieves the best results in small vessel anastomoses. Optimal anastomosis of 1 mm. vessels requires interrupted full thickness sutures with minimal adventitial stripping and the use of the smallest number of sutures possible. We do not advocate routine perfusion of small arteries unless there are specific indications. An experienced team of microsurgeons utilizing these principles along with proper patient selection and a sound postoperative regimen should be able to achieve more than a 70 per cent success rate in replantation of completely amputated digits and hands.