In our trauma services, we treat all kinds of upper and lower extremities which need microsurgical reconstructions. Our Trauma Plastic Surgeons are 24 hours available 7 days a week. The attending staffs will be in charge for every emergent and urgent case, including replantation of any part of the extremities and part of the face or scalp in occasion, revascularization of major vessels of extremities, and coaptation of peripheral nerves. Professor Fu-Chan Wei successfully performed a 10-digit replantation in 1982, and did another incredible digit replantaion after 94 hours of ischemia time in 1985. We are not only familiar with immediate replantations, but also have successful experiences in delayed replantations of digits, who were unstable owing to life-threatening trauma at the beginning and received replantations in 24 hours after intensive care. Salvage transplantation of digits were not unusual in order to achieve basic hand function. For the patients with major organ exposure in an acute setting, we are fully available and experienced to do immediate and early free flap reconstruction day and night. With the effort combined by the orthopedists and microsurgeons, we are able to salvage mangled lower extremities with MESS10 (original critical value was MESS7) and patients can achieve basic functional outcomes. The microsurgeons are skillful in reconstruction of defects, such as bones, soft tissues, nerves, and even functioning muscles. We also eager in exploring new techniques and flaps to decrease morbidity of donor sites. Professor Chih-Hung Lin developed the endoscopic-assisted harvest of gracilis muscle flap, latissimus dorsi muscle flap, rectus abdominis muscle flap, and vascularized sural nerve in our institute. Nowadays, anterolateral thigh flap (ALT flap) is the main workhorse for transfer. We broadly use the versatility of the ALT flap to overcome compound defects with one donor site. The free flap transfer has been promoted to the new era of reconstruction, which is not only for the purpose of simple coverage but mainly for functional considerations.