Customizable foam-based background for leveling the field to perform microvascular anastomosis Dear Editor, Microsurgical anastomosis is critical in free tissue transfer surgery, with success depending on surgeon skill, patient factors, and peri/ post-operative care. Initial difficulties in microvascular anastomosis may necessitate repeat attempts, which pose significant challenges for young microsurgeons, leading to time loss and increased failure risk. While technical proficiency is vital, optimizing the microsurgical field may offer swift improvement and mitigate avoidable errors. Factors to consider include stability, fluid drainage, vessel positioning, visual contrast, and surgeon comfort.Building upon advancements in microsurgical techniques and innovative approaches (Bruce et al., 2015;Davis et al., 2012;Zienowicz et al., 1994), we introduce our novel technique using customizable foam-based backgrounds to optimize the microsurgical field. Furthermore, we will present examples of how the technique can be applied in clinical practice.