We have experienced 29 cases of microvascular surgery during a year since Apr. 1981. We performed 18 cases of composite tissue transfer in 17 patients. 3 cases of axillary flap, 5 cases of dorsalis pedis flap, 4 cases of living fibula transplantation, 2 cases of groin flap using deep circumflex iliac vessels, a case of osseocutaneous flap using the 11th rib, living M-P joint from the 2nd toe to finger, neurovascular island flap from the lateral side of the 3rd finger, and a case of musculocutaneous flap using the gracilis muscle were done. The causes of the soft tissues and/or bone loss were open fracture, which is the most common cause, osteomyelitis, congenital pseudarthrosis of the tibia, bone tumor, and scar contractures, etc. The success rate of the composite tissue transfer was 89%. The 2 cases of failure were observed. The one is due to the vascular damage after the leg lengthening in congenital pseudarthrosis of the tibia and the other due to the infection on the grafted area. The follow up period was from 4 to 18 months. The patients except failed 2 cases were pleased the result of the surgery. The composite tissue transfer using microvascular surgery has many advantages in that the tissue defect can be filled by one stage operation, the patient would be less dependent wish shorter hospital stay, the patient would be less morbid with better function than the patient with multi-staged complex operations. The composite bone and soft tissue transfer used for the infected bony defect made the infection heal more rapidly than the other conventional methods. The deep circumflex iliac artery played a good role in making the osseocutaneous flap, which has many advantages such that Taylor had described. But it is not the truth for the skin only problem. So we darely suggest the third category of the arterial supply to the skin as osseocutaneous artery to supply the overlying skin through the bone, which is exampled with the deep circumflex iliac artery. The vessels in the area of a limb lengthening would be stretched and severely damaged. And the overstretched vessels in limb lengthening should not be used in the microvascular surgery, if the time interval from the traction is not plentifully elapsed and the vessel status is not converted to normal.