Introduction: This study presents an innovative revascularization technique for thumb replantation using arterial conduit and vein transposition. The technique is applicable in segmental injuries necessitating grafting. Methods: Retrospective analysis of all thumb replantations by a single surgeon between 1996 and 2004. Demographics of the patients, mechanism of injury, extent of injury, type of repair and outcome were evaluated. A complete description of the new surgical technique utilizing the deep inferior epigastric artery (DIEA) as an arterial conduit and vein transposition from the index finger will be presented. Results: Twelve patients with thumb amputations were treated. Six patients had segmental injuries and underwent arterial conduit graft and 6 patients underwent primary anastomosis. Of the 6 arterial conduit graft patients, 5 had the DIEA graft and one had an arterial transposition using the dorsal radial artery. Four of these patients required venous transposition from the index finger. Five arterial conduit patients had a crush or avulsion injury. Four patients in the arterial conduit group and five patients in the primary anastomosis group had successful replantations. No donor site complications were encountered. Conclusion: We present a safe and effective technique for segmental injury thumb replantations using an arterial conduit graft and venous transposition.