Indocyanine green, ultrasonography, and Doppler techniques allow evaluation of blood flow but lack real-time microcirculation visualization. This study uses video-capillaroscopy to assess tissue components in microvascular reconstruction. Seven patients undergoing head and neck oncologic reconstruction were evaluated. Results showed optimal visualization in skin, adipose tissue, periosteum, and perforators, while muscle and injured skin showed poor visualization. Video-capillaroscopy offers a reliable method for intraoperative real-time perfusion evaluation. © 2022 Elsevier B.V., All rights reserved.