Four upper extremity replantations were carried out. In one patient amputation was complete at the wrist; a narrow pedicle of skin was spared in one case; one and two traumatized nerves remained in the other two. In two cases, postoperative arterial thrombosis required immediate reexploration with further revision of the artery. Lymph from reimplanted limb was allowed to drain freely through a long releasing incision covered with mesh graft to minimize increase of tissue pressure and likelihood of venous thrombosis. In all, circulation was successfully reestablished and a viable extremity obtained. Two patients have had excellent long-term results. In one patient, the radial nerve, successfully repaired, was inadvertently disrupted at the same level of the initial injury during a secondary procedure. It was repaired again and regenerated fully.