During an 8-year period, 131 multiple microvascular transplants were performed on 62 patients for upper extremity reconstruction of complex wounds. Patients were classified into two groups: In group I 35 patients received paired simultaneous transplantation of 70 flaps performed in 35 operations. Group II consisted of 27 patients who underwent reconstruction with 61 sequentially transferred flaps; each procedure consisted of a single transplant. No statistical differences in flap failure or complications were seen between groups, except that group I required emergency reexploration more frequently. Patients receiving sequential reconstruction required rehospitalization, leading to significantly elevated costs. In our experience, simultaneous multiple microvascular transplants, particularly in patients admitted with acute injuries, result in reduction of costs, total number of procedures, and duration of hospitalization without increased complications.