Indications and approaches for pediatric free tissue transfer have expanded in recent years, and most flaps historically described in the adult population are now routinely used in children. Those embarking on pediatric microsurgical operations must understand expected growth and development and should incorporate these factors into the reconstructive plan. Virtual surgical planning is revolutionizing preoperative planning and intraoperative execution and should be considered standard-of-care in complex cases. New technologies including microsurgical robotics and artificial intelligence will continue to refine and improve pediatric microsurgical outcomes in the years to come.