Microsurgery has enhanced the outcomes in all avenues of upper limb reconstruction. It has helped extend the indications in digital and major replantation and has helped to provide solutions for reconstruction of extensive bone and soft tissue defects. In nerve surgery, it has protocolized the management of brachial plexus injury, large nerve gaps, and neuropathic pain. Aesthesis in reconstruction is given equal importance as functional outcome. Supermicrosurgery has opened up avenues of free style free flaps that have minimized donor site morbidities. Microsurgery has provided new solutions in congenital and acquired lymphedema.