**1. Introduction**

Microvascular anastomosis is a fine art form which requires practice to get it perfect. Perfection is required to repair a vessel that is 2 mm or less in diameter with precision in order to prevent the development of a thrombus resulting in vessel occlusion. In order to achieve this, harmony should be present between the microscope, its operator (the surgeon), and his instruments. With experience, the surgeon may be able to successfully anastomose 1–2 mm diameter vessels with loupes magnification, but it is not recommended for the novice. This chapter is divided into two sections: the first is a **brief description** of the surgeon' s posture, his instruments, patient factors and the environment to illustrate how the harmony results in a better whole. In the second section, the **techniques** on how to accomplish the process without compromising the quality of repair and the **finer points** on how to enhance it will be highlighted to bring the whole orchestra to its crescendo and conclusion.
