Microsurgery
Overview
Microsurgery is a surgical discipline that combines magnification with advanced diploscopes, specialized precision tools and various operating techniques. These techniques are primarily used to anastomose small blood vessels (arteries and veins) and to coapt nerves. Microvascular and microneural coaptation allow for complex repair of human tissue after trauma, cancer and congenital deficiencies. Two of the main purposes of microsurgery are to transplant tissue from one part of the body to another and to reattach amputated parts.
It is incorrect to state that microsurgery is simply a general term for surgery requiring an operating microscope. This loose definition does not convey the breadth and complexity of the specialty. Yes, microsurgeons use microscopes, but that is a small part of what the specialty addresses. In fact, microsurgery encompasses much, much more than this simple definition. The procedures themselves are a mixture of surgical science and art and take many years of training to become proficient.
Microsurgery helps to heal wounds, restore function after trauma, and restore form after cancer. It can assist in the recovery and healing of a wide array of medical issues, from emergency amputations to reconstoration of the human breast.
Read more about : Breast reconstruction
What Is Microsurgery?
Sometimes, your body needs "reconstruction." This can happen when your body does not form in a standard way, when you have an injury (like a trauma), or when you have surgery that removes important tissue. When you are missing tissue that is important either for your body's functioning or appearance, your plastic surgeon might mention "microsurgery."
"Microsurgery" is a type of surgery that allows your own tissue to move from one place on your body to another place on your body. This can be useful if the area of your body that needs reconstruction does not have extra tissue nearby. The surgery itself needs "donor" tissue that can be moved to the "recipient" site (the part of the body that needs reconstruction). When the "donor" tissue is far away from the "recipient," surgeons often need to use a microscope to operate on blood vessels to keep the surgery successful. Using a microscope (or other magnifying lens) for surgery (usually to connect blood vessels) is called "microsurgery."
What Are "Flaps & Free Flaps"?
When you need reconstruction surgery with a plastic surgeon, this might mean that tissue is missing from a particular place on your body. A piece of tissue that is being used in surgery to replace what is missing is called a "flap." "Flap" tissue that is being moved from one place to another in surgery must have a good blood supply before, during, and after the surgery. Your plastic surgeon will recommend a surgery designed to keep the "flap" blood supply strong.
Sometimes, the tissue on your body needed for your "flap" is far away from the part of your body that is being reconstructed. When this happens, the "flap" may be entirely disconnected from your body for a short time during your surgery and then reconnected to your body. This type of surgery is called "free flap" surgery. The reconnection of your flap will include "microsurgery" (described above) to make sure the blood supply to the "free flap" is healthy.
Read more about : Skin Cancer Reconstruction
Common Microsurgery Procedures
. Breast reconstruction using free tissue transfer
. Head and neck reconstruction using free tissue transfer
. Functioning free muscle transfer for certain types of muscle paralysis
. Vascularized bone flap transfer
. Complex wound reconstruction
. Toe transplantation
. Digit replantation
. Nerve repair and grafting
. Lymphatic reconstruction
How Should I Prepare for Microsurgery?
In preparing for microsurgery, you may be asked to:
. Get lab testing or a medical evaluation
. Take certain medications or adjust your current medications
. Stop smoking
. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Microsurgery is typically performed in a hospital setting and will likely use general anesthesia.
What Are the Steps of a Microsurgery Procedure?
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Microsurgical procedures are usually performed under general anesthesia due to their precise nature and often extended duration.
Step 2 – The incision
A free tissue transfer using microsurgery involves a donor site and recipient site. First, the recipient site may be prepared following surgical removal of cancer or scar tissue. Tiny blood vessels and nerves are carefully dissected at the recipient site. Once a suitable donor site is selected, tissue can be isolated on its unique blood supply. The tissue is then disconnected from the body, and blood vessels are reattached at the recipient site using an operating microscope.
Step 3 – Closing the incisions
Depending on your condition and specific procedure, you may have incisions that need to be closed with removable sutures, skin adhesives, or dissolving sutures.
Step 4 – See the results
The results of microsurgery will develop over time as swelling subsides. Your final outcome may not be realized for several months.
What Are the Risks of Microsurgery?
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.
The possible risks of microsurgery include, but are not limited to:
. Anesthesia risks
. Asymmetry
. Bleeding
. Deep vein thrombosis, cardiac and pulmonary complications
. Fatty tissue found deep in the skin might die (fat necrosis)
. Fluid accumulation (seroma)
. Hematoma
. Infection
. Numbness or other changes in skin sensation
. Persistent pain
. Poor healing of incisions
. Possibility of revisional surgery
. Recurrent looseness of skin
. Skin discoloration and/or prolonged swelling
. Skin loss or tissue necrosis
. Suboptimal aesthetic result
. Unfavorable scarring
These risks and others will be fully discussed prior to your consent. It's important that you address all your questions directly with your plastic surgeon.
What Should I Expect During My Microsurgery Recovery?
Following your microsurgery procedure, gauze dressings or bandages will be applied to your incisions. An elastic bandage or compression garment may minimize swelling and support the donor site as it heals following surgery.
Close monitoring of blood flow is always required following a microsurgical procedure, preferably in a hospital setting with dedicated staff who are familiar with caring for patients who have undergone microsurgery. Free flap monitoring depends on the operation and surgeon preference.
Small, thin tubes may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
You will be given specific instructions that may include:
. How to care for your surgical site(s) following surgery
. Medications to apply or take orally to aid healing and reduce the risk of infection
. Specific concerns to look for at the surgical site or in your general health
. Certain activity restrictions
. When to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
. Where will I be taken after my surgery is complete?
. What medication will I be given or prescribed after surgery?
. Will I have dressings/bandages after surgery? When will they be removed?
. Will there be drains? For how long?
. When can I bathe or shower?
. When can I resume normal activity and exercise?
. When do I return for follow-up care?
Healing will continue for several weeks as swelling decreases. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
Source:
https://www.plasticsurgery.org/reconstructive-procedures/microsurgery
https://www.microsurg.org/for-patients/what-is-microsurgery/