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The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively.First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2).There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P < 0.001). The average external bleeding period was 7.2 days. The mean hospital stay was 12.4 ± 1.5 days for group 1, which was significantly longer when compared with group 2 (5.2 ± 0.5 days, P < 0.001).Although palmar vein anastomosis did not show a statistically significant effect on relieving venous congestion, it reduced the rate and the severity of venous congestion. Also, replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis–only replantations.