Orthopedic surgery is a surgical specialty that treats a multitude of conditions related to the musculoskeletal system. The proper handling of soft tissues is paramount to successful outcomes in all elective and trauma cases. Compromise of the soft-tissue envelope often results in morbidity, increased costs of care, readmission, and the need for salvage procedures often requiring complex pedicle flaps or free tissue transfer, resulting in donor site morbidity. Over the last half century, the use of the operating microscope and reconstructive microsurgical techniques has revolutionized the care of patients affected by extremity trauma, tumor, infection, and congenital differences. Developed 25 years ago, the orthoplastic approach to extremity reconstruction has integrated the principles and practices of orthopedic surgery and plastic surgery into 1 discipline to optimize care of extremities relying heavily on microsurgical techniques. Armed with this approach and discovering new applications of microsurgical techniques has expanded the possibilities for limb salvage in patients who otherwise would have been considered for amputation.