Insights into the identification, prevention, and treatment of neurovascular compromise in upper extremity surgery are provided in this chapter, focusing on commonly encountered injuries susceptible to intraoperative or postoperative issues. The authors highlight the importance of knowledge of anatomy, meticulous dissection, and preparation to navigate complex surgical scenarios effectively. Furthermore, proactive approaches to managing difficult situations encountered during surgery are outlined, emphasizing timely recognition and decisive action. Patient outcomes can be optimized by preventing neurovascular compromise in upper extremity surgery.