Digital replantation, free tissue transfer, vascularized bone grafting, and other procedures have become possible with the advent of microsurgery. A basic set of instruments should include microsurgical forceps (4, 5A), vessel dilating forceps, curved scissors, straight scissors, and vascular clamps (single and double for both arteries and veins). For more advanced procedures, surgical background with color contrast, microsutures, and microirrigation syringes are needed. Surgical setup and choice of sutures are explained. The advantages, disadvantages, and procedures for magnification with operating loupes and operating microscopes are detailed. Microsurgical tools require specialized handling, care, and storage conditions. The technique of end-to-end arterial and venous repair, nerve repair, and neuroentubulation is presented.