Microsurgery has evolved into an integral part of reconstructive surgery, particularly in the extremities, breast, and head and neck. High success rates have been documented by several large centers. Microsurgery is also practiced in the private setting, but success rates in private practice are poorly documented. A review of a single surgeon's first, consecutive 100 free flaps is presented. Recipient sites include the lower extremity(57%), breast(15%), femoral head(9%), chest wall(1%), hand(5%), and head and neck(13%). Ten flaps were re-explored within the first 36 hours; nine of these flaps were salvaged (90%). Re-exploration revealed venous occlusion in 7 patients, arterial occlusion in 1, and hematoma under the flap in 2. In addition to the one flap that failed despite re-exploration, two additional flaps failed. One was discovered obviously nonviable on post-op day three and another patient returned after discharge with a nonviable flap. Of the three flaps that failed, two patients had subsequent succesful reconstructions with a second free flap and one patient underwent below knee amputation. There were two patient deaths within the first month following surgery, one from a stroke and one from an apparent myocardial infarction. The review also demonstrated an increasing interest in and use of perforator flaps. Of the first fifty flaps performed, 16% were perforator flaps while 54% of the second fifty flaps were perforator flaps. Two of the three flaps lost were perforator flaps but there was no statistical difference between complications in the perforator and non-perforator groups. This review suggests that high microsurgical success rates are possible in private practice and that perforator flaps can be successfully learned and performed in private practice.