The origins of the microvascular anastomosis can be seen throughout the 19th century and early 20th century. The first end-to-end anastomosis was described by Murphy in 1897, with Carrel building on this work.1 He introducing the triangulation method, earning himself the Nobel prize in 1912.1 McLean’s discovery of heparin in 1916 was a major step forward in the reliability of the anastomosis. Followed shortly after the invention of the first surgical microscope by Carl Zeiss in 1954, came the first recorded microvascular anastomosis by Jacobson and Suarez in 1960.1 Its first clinical application was seen in trauma, with the surgical replantation of a proximal arm, with techniques evolving to allow replantation of an amputated hand.1 Shultz and Buncke became the founding fathers of microsurgery in the 1960s, believing that microsurgery needed to be able to reliably anastomose a 1mm vessel.2 To assist in their experiment to replant a rabbit ear using 1mm vessels, they developed the microsuture, and adapted instruments from the jewellery field.2 Buncke went onto perform the first single stage toe to thumb on Monkeys in 1966, followed by the first cutaneous free flap being performed by Daniel and Taylor in 1973.1.2 These discoveries revolutionised replantation and transplantation surgery, along with opening the door for modern reconstructive surgery. References: 1.Yoo H, Kim BJ. History and recent advances in microsurgery. Arch Hand Microsurg. 2021 July;26(3):174-183. Doi: DOI:10.12790/ahm.21.0097. 2.Buncke GM. History of Microsurgery: The Legacy of Harry J. Buncke, MD. Semin Plast Surg. 2022 Dec 19;36(4):211-220. doi: 10.1055/s-0042-1758130. PMID: 36544811; PMCID: PMC9762998.