The application of microvascular technics to problems in reconstructive surgery has enabled the surgeon to revascularize ischemic digits, replant amputated digits, and to transfer directly composite tissue from one area of the body to another for reconstructive purposes. The success of these procedures is directly dependent upon the ability to perform and maintain patent microvascular anastomoses. Representative cases are reported including the revascularization of an incompletely amputated digit, the replantation of an amputated thumb, the direct transfer of a toe to replace a missing thumb, and the transfer of a groin flap to cover a lower extremity defect. The principles of preoperative management, operative technics, and postoperative care are reviewed.