Microsurgery

Microsurgery is a surgical technique that involves using specialized instruments and a high-powered microscope to perform intricate procedures on very small structures in the body, such as blood vessels, nerves, and lymphatic vessels. This type of surgery requires highly skilled surgeons who are trained in the use of microscopes and specialized instruments.

Microsurgery is commonly used in a variety of medical fields, including plastic surgery, neurosurgery, and reconstructive surgery. It is also used in the treatment of conditions such as lymphedema, cancer, and vascular disease. 

Definition and Overview

Microsurgery is a surgical approach that involves using a high-powered microscope and specialized instruments to operate on tiny structures in the body, such as nerves and blood vessels that are about 1mm in diameter. This technique has allowed for successful procedures like tissue transfer and reattachment of severed parts. Many medical fields like orthopedics, neurosurgery, plastic surgery, and more use microsurgical techniques to perform intricate procedures. (1)

Types

Microsurgery is a technique that many plastic surgeons use to perform specialized procedures such as transferring tissue from one part of the body to another, reattaching severed body parts, and transplanting composite tissue. These procedures are very individualized and complex and are usually performed when other options like skin grafting, primary closure, or flap transfer are not adequate for reconstructive surgery problems. Some common microsurgery procedures include:

• Vascular microsurgery: Vascular microsurgery involves repairing small blood vessels, such as those in the hand or foot, using a microscope and specialized instruments.
• Nerve microsurgery: This involves repairing damaged nerves, often in the hand, arm, or leg, to restore function and sensation.
• Lymphatic microsurgery: This procedure involves repairing the lymphatic system, often in the case of lymphedema, to improve drainage and reduce swelling.
• Replantation: Replantation involves reattaching severed body parts, such as fingers or toes, using microsurgical techniques.
• Free tissue transfer: This involves taking tissue, such as skin or muscle, from one part of the body and transplanting it to another, often in the case of reconstructive surgery.
• Ocular microsurgery: Ocular microsurgery involves performing delicate procedures on the eye, such as repairing a detached retina or removing a cataract.
• Gynecological microsurgery: This involves performing procedures, such as tubal ligation reversal or ovarian cyst removal, using microsurgical techniques.

These are just a few examples of the many procedures that can be performed using microsurgical techniques.(2,3)

Candidates

Candidates for microsurgery are typically those who require surgical intervention on very small structures in the body, such as blood vessels, nerves, and lymphatic vessels. Microsurgery is often used in cases where traditional surgical techniques are not feasible or would result in a less optimal outcome. Examples of conditions that may require microsurgery include:

• Reconstruction after cancer surgery: Microsurgery can be used to rebuild soft tissue and blood vessels that were removed during cancer surgery.
• Trauma: Microsurgery can be used to reattach severed body parts, repair nerves, and blood vessels, and restore function and sensation after a traumatic injury.
• Vascular disease: Microsurgery can be used to repair small blood vessels, often in the hand or foot, that have been damaged by vascular disease.
• Lymphedema: Microsurgery can be used to improve lymphatic drainage and reduce swelling in patients with lymphedema.
• Congenital abnormalities: Microsurgery can be used to correct congenital abnormalities, such as cleft lip and palate.

The decision to use microsurgery will depend on the specific condition and the individual patient's needs and circumstances.

Risks and Side Effects

Before undergoing microsurgery, the plastic surgeon and staff will provide patients with detailed information about the risks associated with the procedure. Patients will be asked to sign consent forms to confirm that they understand the specific procedures and any potential complications. Some of the risks associated with microsurgery may include:

• Risks associated with anesthesia
• Bleeding
• Deep vein thrombosis, cardiac and pulmonary complications
• Fatty tissue may die (fat necrosis)
• Fluid accumulation (seroma)
• Hematoma
• Infection
• Changes in skin sensation or numbness
• Persistent pain
• Poor healing of incisions
• Possible need for revisional surgery
• Recurrent looseness of skin
• Skin discoloration and prolonged swelling
• Skin loss or tissue necrosis
• Suboptimal aesthetic result
• Unfavorable scarring

All these risks should be fully discussed between the surgeon and the patient. It is important to make sure that patients clearly understand the potential risks and benefits of the procedure.(5)

Post-Procedure and Follow-up

After microsurgery, gauze dressings or bandages will be applied to your incisions, and an elastic bandage or compression garment may be used to minimize swelling and support the donor site. Small tubes may also be placed under the skin to drain excess blood or fluid.

Monitoring of blood flow is required following microsurgery, preferably in a hospital setting with specialized staff. Your plastic surgeon will provide specific instructions on how to care for your surgical site, including medication to aid healing and reduce infection risks, activity restrictions, and signs to look out for at the surgical site or in your general health.

The final results of microsurgery may take time to develop and may vary depending on the procedure used.(6)

Recovery 

The surgeon provides specific instructions, including how to care for surgical site(s) after surgery, medication to take or apply for healing and infection prevention, potential signs of concern to watch for, activity restrictions, and when to schedule follow-up appointments with the surgeon. (7)

Results

Microsurgery results may not be immediately apparent due to swelling and can vary based on the specific procedure. While microsurgery has advanced the field of reconstruction and replantation, results cannot be fully predicted. Complete restoration of function may not be possible in some traumatic injuries, and further surgeries may be required for optimal results.

If a patient experiences chest pain, shortness of breath, or abnormal heartbeats after going home, it is essential to seek medical attention immediately. Excessive force, motion, or abrasion to surgical incisions during the healing process should be avoided based on the doctor's instructions to ensure a successful surgery. (8)