Venous anastomosis is an important component of distal replantation. However, if no veins are available, artery-only replantation is performed using an external bleeding method. The purpose of this study was to examine cases wherein fingertip replantation was performed without venous anastomosis at our hospital. This retrospective study included 53 consecutive patients（56 fingertips） who underwent fingertip replantation without venous anastomosis between 2006 and 2020. All patients underwent complete amputation distal to the distal interphalangeal joint（Ishikawa’s subzones I-IV）. The overall survival rate was 92.9%（52/56）. Survival was achieved in 100%, 95.8%, 100%, and 75.0% of those with subzone I, II, III, and IV amputations, respectively. Subzone IV was associated with a significantly lower rate. Single-digital arterial anastomosis was established in 50 digits, and two-artery anastomosis was established in 6. Interpositional venous grafts were used in 12 digits to reconstruct the digital artery. The numbers of arterial anastomoses and interpositional venous grafts were not correlated with the survival rate. The mean duration of external bleeding was 5.0 days. Six of 53 patients required blood transfusion. We concluded that subzones I to III are the limiting levels of artery-only replantation.
