Replantation of digits remains one of the most difficult challenges of plastic and reconstructive surgeons. Since the first successful operation, indications and contraindications for replantations have been well established. The ultimate goals in replantation should be measured in terms of survival and successful functional rehabilitation to include both motor and sensory function, late amputation rate, and return to work or pre-trauma functional status. From July 1, 2001 through December 9, 2002 we performed 24 digital replantations in the division of plastic surgery at the UMDNJ/New Jersey Medical School, Newark, New Jersey. Our patients ranged in age from 4 months to 49 years of age. We would like to present four cases which presented very difficult challenges for us and describe the techniques we utilized to overcome these difficulties. These included the replantation of small fragments in an adult, the combination of atherosclerosis of the digital vessels and the use of long vein grafts greater than 5 cm in an elderly patient, the treatment of a ring avulsion injury, and finally the utilization of transpositional microsurgery. All of these patients were able to return to their previous level of activity with excellent motor and sensory function.