Post-burn scar contractures represent one of the most challenging reconstructive problems in plastic surgery, often requiring complex microsurgical interventions to restore function and aesthetics. This comprehensive review examines current microsurgical approaches for burn scar reconstruction, including free tissue transfer, vascularized composite allotransplantation, and innovative techniques for complex contracture release. Understanding the principles of microsurgical reconstruction is essential for optimizing functional outcomes and improving quality of life in burn survivors.