Micro surgery

About The Treatment

Microsurgery is a highly specialized field of surgery performed by plastic surgeons, involving the use of operating microscopes and precision instruments to perform intricate procedures on small structures such as blood vessels, nerves, and tissues. This advanced surgical technique is critical in various reconstructive procedures to restore function and form.

Key Applications of Microsurgery

Free Tissue Transfer (Free Flaps)

• Definition:

  • Transplanting tissue from one part of the body to another, along with its blood supply.

    
    

• Procedure:

  • Involves connecting tiny blood vessels and sometimes nerves to the recipient site using microsurgical techniques.

    
    

• Common Uses:

  • Breast reconstruction post-mastectomy (e.g., DIEP flap)

  • Head and neck reconstruction following cancer surgery

  • Limb salvage procedures for trauma or chronic wound

    
    

Replantation

• Definition:

  • Reattachment of completely severed body parts, such as fingers, hands, or arms.

    
    

• Procedure:

  • Involves rejoining bones, tendons, muscles, blood vessels, and nerves.

    
    

• Indications:

  • Traumatic amputations.

    
    

Peripheral Nerve Repair

• Definition:

  • Repairing damaged nerves to restore function.

    
    

• Procedure:

  • May involve direct nerve repair, nerve grafting, or nerve transfers.

    
    

• Common Conditions:

  • Brachial plexus injuries, carpal tunnel syndrome, traumatic nerve injuries.

    
    

Lymphedema Surgery

• Definition:

  • Procedures to improve lymphatic drainage.

    
    

• Procedure:

  • Includes lymphovenous bypass and vascularized lymph node transfer.

    
    

• Indications:

  • Lymphedema secondary to cancer treatment or congenital causes.

Techniques and Equipment

Operating Microscope

• Provides high magnification and illumination, enabling surgeons to see and manipulate tiny structures.

  
  

Micro-Instruments

• Precision tools designed for delicate handling of tissues and structures.

• Includes micro-scissors, forceps, and needle holders.

  
  

Sutures and Needles

• Ultra-fine sutures (often finer than human hair) for delicate tissue repair.

• Specialized needles for microvascular and nerve anastomosis.

  
  

Fluorescence Angiography

• Used intraoperatively to assess blood flow in microvascular procedures.

Common Microsurgical Procedures

Breast Reconstruction

• DIEP Flap (Deep Inferior Epigastric Perforator Flap):

  • Uses skin and fat from the lower abdomen while preserving the abdominal muscles.

    
    

• TRAM Flap (Transverse Rectus Abdominis Muscle Flap):

  • Involves the use of lower abdominal skin, fat, and muscle.

    
    

Head and Neck Reconstruction

• Fibula Free Flap:

  • Used for mandibular reconstruction.

    
    

• Radial Forearm Flap:

  • For reconstructing soft tissue defects.

    
    

Trauma Reconstruction

• Toe-to-Hand Transfers:

  • Reconstructing digits using toes.

    
    

• Free Muscle Transfers:

  • For functional restoration in cases of severe muscle loss.

Post-Operative Care and Rehabilitation

Monitoring

• Flap Monitoring:

  • Frequent checks for flap viability using clinical assessment and Doppler ultrasound.

    
    

• Nerve Regeneration Monitoring:

  • Regular assessments to track recovery of nerve function.

Physical and Occupational Therapy

• Essential for restoring function and range of motion.

• Includes exercises, splinting, and functional training.

Pain Management

• Use of analgesics and, in some cases, nerve blocks.

  
  

Long-Term Follow-Up

• Regular follow-up appointments to monitor healing and functional outcomes.

• Additional surgeries may be required for optimal results.

Advancements in Microsurgery

Supermicrosurgery

• Involves anastomosing blood vessels smaller than 0.8 mm.

• Used in lymphatic surgery and fingertip replantation.

  
  

Robotic-Assisted Microsurgery

• Enhances precision and control during complex procedures.

  
  

Tissue Engineering and Regenerative Medicine

• Emerging technologies to improve outcomes in reconstructive surgery.