A posterior-wall-first anastomotic technique has significant advantages over the traditional method of microvascular anastomosis. Since July, 1979, the posterior-wall-first anastomosis has been used in 17 consecutive replantations involving 31 fingers or parts with a success rate of 97%. In addition 20 composite tissue transplants were carried out using the same technique with a success rate of 95%. The technique is described in detail and the advantages clearly stated.