The recent advance in microsurgery has a great impact on our daily practice at emergency department in Taiwan. Many challenging cases such as digital amputation, crushed upper limb, open fracture, mangled lower extremity, brachial plexus injury, osteomyelitis, diabetic foot, and even bedsore, can be effectively solved by the adequate intervention with microsurgery. This paper described the current trend of microsurgery application in orthopedic trauma & emergency care. An update knowledge on the microsurgical field and well-organized team work are mandatory for physicians dealing with trauma cases in the modern setting of emergency department.