The use of interposition vein grafts has been associated in the literature with a high complication and flap failure rate. Ninety-three vein grafts in 55 patients over a 46-month period were analyzed to evaluate the clinical reliability of vein grafts in a predominantly trauma patient population (37/55). Fifty-two arterioarterial grafts and 41 veno-venous grafts were performed. A-V loops prior to flap transfer were created in 26 patients. The revision rate was 14.8 percent, with a salvage rate of 75 percent. Flap survival was 96.2 percent, compared to 96.7 percent for a large series of flaps without vein grafts. It can be concluded from the study, that the use of vein grafts is not associated with a higher flap failure rate, when technical pitfalls can be avoided, and close monitoring by an experienced staff is guaranteed.