43 microvascular procedures were performed in 38 children, (age limit 15 years) over a three year period. The average age was 5.4 years. The majority of the procedures were elective (63%), the remainder urgent or emergency. The overall vascular success rate was 93%, confirming previous reports. Three failures were observed, 2 of these being thumb avulsion injuries, the third a free-flap. Two patients underwent re-exploration of the anastomosis with successful outcomes. Vessel size was not a problem and generally exceeded 0.8 mm external diameter. The total time under anaesthetic averaged 5.5 hours, and post-operative recovery included monitoring and pain control on a High Dependency Unit. The average hospital stay was 10 days. The indications for surgery differ from those in adults, management is more complex, and includes the physical and psychosocial care of the child and parents. Despite raising certain anxieties in the past, microvascular surgery in children is safe, reliable and carries a high success rate.