Advances in microsurgical techniques have permitted replantation and reconstructive procedures to restore amputated or injured parts with a high degree of success in children. Despite this progress, some technical concerns remain. During a 15-year period, replantations were done in 53 children with major limb (18), hand (10), or digit (25) amputations. Even in patients with crush or avulsion injuries, the results suggest that replantation procedures are justified considering the superior recuperative ability in children. Free tissue transfer was used for reconstructive procedures in 26 children, including free flaps, vascularized bone transfers, nerve grafts, and toe-to-thumb transfers. The microsurgical success rate was 86.8% for replantation procedures and 96% for reconstructive procedures. Although the technical aspects and outcome of replantation attempts still differ between adults and children, there appears to be little difference in free tissue transfer. Thus, most replantation and reconstructive procedures can be attempted with a high possibility of success in children.