Microsurgery is an important skill for vessel and nerve repair, reconstruction, and limb salvage. Fine skills are critical for good outcomes and involve a specialized skillset and special considerations including regarding ergonomics. It is critical for microsurgical procedures to involve adequate planning. For a good outcome, thorough knowledge of the anatomy including perforators and the tissues required and those available is critical. Patient selection and optimization also play a role in microsurgical planning and execution. Proper microsurgical technique and understanding of the tissues involved aids in successful execution of reconstruction and restoration of form and function.