**Abstract**

Microvascular anastomosis is a highly skilled surgical technique that requires the assistance of optical magnification via an operating microscope or loupes to be fully visualised and thus accomplished reasonably well. It demands the full attention of the surgeon throughout the procedure. Even the smallest of inadvertencies may result in disastrous results. Practice has no shortcut and the more experienced a **skilled** surgeon is, the better his results. The chapter begins with a detailed account of preparedness in the operating room, for preparation is the path to success. There are however tips to reduce the incline of the learning curve and points to remember when things are not quite going right. This chapter attempts to deal with those moments.

**Keywords:** arterial repair, microvascular anastomosis, replantation, revascularization techniques, venous repair and grafting
