This chapter introduces microsurgical methods for joint reconstruction in the hand, emphasizing free vascularized joint transfers from the foot as a solution for bone, extensor tendon, and soft tissue defects, including joints. The surgical technique involves radical debridement, preserving viable structures, marking vessels and nerves, and planning the operation based on preserved structures and patient needs. For foot-to-hand transfers, the radial artery and cephalic vein are dissected on the dorsal hand, while veins on the injured finger’s dorsal side and one digital artery are prepared if a joint transfer is needed. At the donor site, skin flaps are obtained from the second toe’s PIP and MTP joints. Dorsalis pedis, the first dorsal metatarsal artery, and great saphenous vein are transected, and the joint is dissected from surrounding tissues, preserving the vascular system, extensor tendon, and skin. The joint is then transferred to the hand defect and fixed, often using cerclage wires and K-wires. Postoperatively, patients receive appropriate medications, and continuous brachial plexus blocks provide analgesia. Close monitoring ensures early detection of vascular insufficiencies. Rehabilitation starts 3 weeks after surgery, and radiographic examinations occur 4 weeks postoperatively, with K-wire removal scheduled 4 to 6 weeks postsurgery. In conclusion, joint reconstruction in the hand is challenging, with varying methods available, such as arthrodesis, joint arthroplasty, and vascularized and nonvascularized joint transfers. Among these, vascularized joint transfers are considered closest to the ideal solution, preserving all joint components and offering growth potential. Free vascularized joint transfers, though difficult, have shown promise, especially in cases where motion must be preserved. Overall, patient age, motivation, and the integrity of the flexor mechanism are key factors in determining the suitability of this approach.