Reconstructive microsurgery, where specialized operating microscopes and precision instrumentation are utilized to perform intricate operations in very small fields, is a rapidly evolving specialty. Dr. Joseph Serletti, Chief of the Division of Plastic Surgery at the University of Pennsylvania Perelman School of Medicine, oversees the largest reconstructive microsurgery program by volume in the country, performing over 700 free tissue transfers for breast, head & neck, and extremity reconstructions. Dr. Serletti discusses the nuances of these complex procedures, as well as updates on the next horizons in reconstructive microsurgery such as facial and hand transplants and replants.