Microvascular anastomoses for the transfer of viable tissue are the basis of reconstructive surgery, and they are used to treat a broad spectrum of clinical problems. Recent advances in technology are promising in the improvement of microsurgery outcomes. The primary threat in reconstructive surgery is anastomotic vascular thrombosis, which can lead to tissue loss with potentially destructive consequences. Postoperative monitoring of tissue perfusion is critical because early recognition of vascular compromise and a rapid surgical intervention are associated with tissue recovery. Conventional flap monitoring methods used to be the primary means of monitoring during post-operative follow-up, but they were highly subjective and observer dependent. Medical devices introduced in flap monitoring have eliminated many of these shortcomings and have greatly im-proved this critical stage of reconstructive surgery. Although the features of the ideal monitoring device have been defined, there is no existing device that could meet all the currently expected requirements. In the near future, we are more likely to see further enhancement and clinical applications of existing technologies.