We describe a technique using the reversed radial artery for distal revascularisation or replantation in the hand. This technique has been used for revascularisation following crush avulsion injuries associated with a large zone of trauma and polydigit replantation. The technique involves dividing the radial artery and venae comitantes proximally and mobilising it distally into the hand for anastomosis. Temporary 'syndactylisation' of adjacent digits is also described. This can be used to convert multiple digits into a single vascular unit and to provide a bed for the transposed radial vessels. These techniques are an option when there is extensive injury to distal vessels such that end-to-end anastomosis is not possible and interposition venous micrografting may be difficult or prone to failure due to poor quality recipient vessels and the need to place grafts in a traumatised bed.