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INTRODUCTION The use of the classic two-ends anchoring technique is common in end-to side (ES) microvascular anastomosis. The literature on the Toe-first (TF) technique is limited. In the current study we present the successful outcomes with the TF technique in ES anastomoses in rat femoral vessels model. METHODS ES microvascular anastomosis with the toe-first technique was performed in the femoral vessels of 10 Sprague Dawley rats. Two-throw reef knots interrupted sutures were used in all the cases. Individual parameters during the procedure were recorded for analysis. The immediate and delayed (cut open technique after 2 weeks) patencies were confirmed. An illustrative case showing the use of the above technique in STA-MCA bypass in a pediatric Moya-Moya disease case is included. RESULTS The average suturing time was 40.14±5.30 minutes, the procedures were completed with an average of 14.57±1.90 sutures. The average time per suture was 2.78±0.43 minutes. The immediate patency was 100% (10/10 cases). Two rats died of unknown cause in the observation period. The delayed patency was 100% in the remaining 08 cases (average observation - 29.6 days). CONCLUSION The TF interrupted suture technique of ES microvascular anastomosis with two-throw reef knots is feasible with excellent immediate and delayed patency rates. The distinct advantages of the TF are the continuous visualisation of the recipient lumen during anastomoses, avoiding back-wall bites and the ability to correct any discrepancy in the recipient-donor lumens during the procedure.