We review a 10-year experience with multiple microvascular transplants (MMTs) performed on 94 patients undergoing reconstruction of complex extremity and head and neck wounds. One hundred ninety-eight flaps were performed with an overall success rate of 95%. Patients were classified into two groups: Group I comprised 38 patients who received simultaneous MMTs (76 total flaps); two flaps were transplanted in the initial operative procedure. Group II consisted of 56 patients undergoing reconstruction with sequentially transplanted MMTs (122 total flaps). The success rates of the two groups were not statistically different (97% vs. 93.4%). Complications were similar in both groups, although sequential reconstruction of lower extremity wounds had a higher frequency of complications and flap failures than the simultaneous method. Patients receiving simultaneous MMTs required more emergent reexplorations, but salvage rates were high (87.5%), particularly in upper extremity reconstructions. We suggest that simultaneous MMTs are a reliable, cost-effective method of reconstructing complex injuries. They reduce patient morbidity by eliminating second hospitalizations and reoperations without increased complications or flap failure.