From March 1983, 20 patients had undergone reconstruction of the upper limb with 22 vascularized composite tissue grafts. The microsurgical procedures had several advantages for reconstruction of injured upper limbs as follows: 1. Free tissue transfer was quite an important and attractive procedure for reconstruction of an injured limb, expecially an upper limb. 2. Free vascularized transfer of composite tissue with its overlying skin was a reliable technique to obtain full thickness soft tissue coverage of a severely injured upper limb when more conservative procedures, such as the use of skin graft or local muscle flaps, had failed or were not feasible. 3. A simple skin flap could be transfered to close an open wound of the limb, but a sensory flap or a special flap such as a nail-skin, tendon-skin or muscle-skin flap was a much better donor for reconstructing the function of the upper limb. 4. When appropriate, the wrap-around procedure was the method of choice for thumb reconstruction because the great toe was preserved. The procedure provided length, stability and adequate sensibility for a functional pinch and grasp. 5. The cosmetic effect of a second-toe transplant might be inferior to the wrap-around flap, but it had the great advantage of being able to provide mobile joints in the reconstructed thumb. As far as the donor foot was concerned, no patients had real trouble functional impairment.