The importance of splenic preservation in reducing the risk of overwhelming post-splenectomy sepsis as well as the heightened awareness of transfusion-related infections have led to changing concepts in the management of blunt splenic trauma. A 10-year retrospective review (1980-1989) of blunt splenic trauma at a Level I trauma center is presented. One hundred eighty five blunt splenic injuries were treated, with a mortality rate of 7 per cent. Splenorrhaphy was performed in 7 per cent of patients in the first 5-year period (48% underwent splenectomy, and 45% were managed nonoperatively). The rate of splenorrhaphy increased to 22 per cent during the second 5-year period, with a subsequent decrease in both splenectomy (39%) and nonoperative management (39%). During the last year of review, 65 per cent of bluntly injured spleens were able to be salvaged (35% managed by splenorrhaphy and 30% by observation). Blood usage averaged 1.1 units/patient in the nonoperative group, 3.3 units/patient in the splenorrhaphy group, and 7.9 units/patient in those undergoing splenectomy. Nonoperative management of blunt splenic trauma can clearly be successful. However, patients chosen for this method should be completely hemodynamically stable to avoid requiring blood transfusions. A combination of early operation and splenorrhaphy with the use of autotransfusion devices, remains a better alternative in the less stable patient with multiple injuries. This method provides for a high rate of splenic salvage while decreasing the need for homologous blood transfusions.