An introduction summarizes the history of the development of flap surgery and puts the discovery of the fasciocutaneous flaps into historical perspective. The anatomical work underlying this discovery is presented and the way in which it has led to improved designs of flaps on the limbs is then described. Finally, the increased refinement and sophistication in the application of all types of flaps is demonstrated by a description of recent advances in the use of microsurgical free tissue transfer in 3 key areas of reconstructive surgery.