Microsurgery has evolved significantly over centuries marked by pivotal advancements in technique, technology and successful procedures. In the 16th century, Paré introduced the concept of vascular repair, laying the foundation for microsurgical techniques. This progress continued in 1759 with the first successful brachial artery repair in England. The 20th century witnessed remarkable strides. Carrel's development of the triangulation method for vascular anastomoses in 1902 revolutionised surgical approaches, earning him the Nobel Prize in 1912. Subsequent innovations, including McLean's discovery of heparin in 1916, contributed to improved outcomes. The 1960s marked a turning point with significant achievements worldwide. Malt and McKhann performed the first arm replantation, while Konatsu and Tamai achieved successful thumb replantation. Pioneering toe-to-thumb transfer procedures were also conducted in China and England. Throughout the 1970s, microsurgery continued to advance with groundbreaking procedures like the introduction of the omental free flap by McLean and Buncke and the free groin flap for foot salvage by Daniel and Taylor. By the 1980s-1990s, microsurgical success rates exceeded 95%, reflecting ongoing refinements in techniques and outcomes. Major breakthroughs in the late 20th and early 21st centuries further propelled microsurgery. The world witnessed the first successful hand transplant in 1998 and facial transplant in 2005. The introduction of "free-style" flap concept by Mardini and Wei further offered greater flexibility in flap harvest in 2003. These milestones underscore the remarkable evolution of microsurgery, redefining possibilities in reconstructive surgery.