Plastic Surgery Essentials for Students-Chapter 22: Microsurgery

Chapter 22: Microsurgery

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Microsurgery is a specialized surgical technique involving the use of precision instruments and a microscope to perform intricate operations on small anatomical structures such as arteries, veins, nerves, and lymph vessels. Key applications include free tissue transfer (often referred to as "free flap" surgery), appendage replantation or reconstruction, and vascularized composite allotransplantation, which can involve face and hand transplants. The tissues transferred can include skin, muscle, tendons, bone, nerves, and lymph nodes, selected based on their vascular pedicle to ensure survival once transferred to another body region.<br /><br />Microsurgery is essential when adequate outcomes can't be achieved through simpler methods, especially in cases of severe tissue loss exposing vital structures like joints, bones, or nerves. It is crucial in reconstructive procedures, such as breast reconstruction post-mastectomy, and in correcting congenital deformities, performing gender affirmation surgery, or treating lymphedema.<br /><br />The chapter outlines various free flap types, which include isolated tissue flaps, composite flaps, and appendage flaps, as well as allogeneic composite tissue transfers. It details specific considerations for performing microsurgery, noting that patient age is less critical than overall health, although systemic diseases and lifestyle factors like smoking can contraindicate or complicate surgery.<br /><br />The operative technique demands high precision, with sub-millimeter vessels requiring magnification tools like loupes or a microscope, alongside exacting suture techniques for vessel anastomosis. Post-operative monitoring for complications focuses on observing physical signs and using devices like Dopplers to ensure proper blood flow and vessel function.<br /><br />Advanced training in microsurgery is essential due to the specialized technical skills required, often provided in hands-on lab settings with models to simulate human conditions. Proper training enhances the foundational skills necessary for successful surgical outcomes in microsurgical procedures.

Keywords

microsurgery

precision instruments

free tissue transfer

appendage replantation

vascularized composite allotransplantation

reconstructive procedures

congenital deformities

gender affirmation surgery

post-operative monitoring

advanced training