Microsurgery includes reconstructive surgery techniques of anastomosis of small vessels (MicroVascular surgery) and coaptation of nerves (MicroNeural surgery). It uses a microscope or a high-magnification loupe to help in performing reconstructive surgery.
Microsurgery is performed for solving difficult reconstructive surgery dilemmas and problems. It is performed when the primary options of reconstruction like primary closure; wound healing by secondary intention; skin graft; and local or regional flap transfer are not possible.
Microsurgery comes much later in the reconstructive ladder. It is usually not the first choice except in certain circumstances. However, it offers the reconstructive surgeon an important tool to achieve complex reconstructive surgery by allowing the transfer of free tissue from distant sites.
Transfer of free tissue may include several different types like isolated tissue transfer; composite tissue transfer; functioning free muscle transfer; vascularized bone graft; and toe transplantation.
In breast reconstruction, breast tissues may be built from the abdominal skin-fat layer by microsurgery; with silicon implants covered by a large muscle; or may also be built gradually by micro-fat grafting technique following liposuction. Additionally, it may also include some specific tissue transfers like nerve graft and vein graft.
In some cases, like in large defects of the face resulting from the removal of a tumor, transferring free tissues may be the best option for the closure of the resultant defect.
In large complicated open tibia fractures, microsurgery now plays a greater role in initial coverage, wound healing, and early mobilization. Dr. Marko Godina, a visionary plastic surgeon from Slovenia has played a tremendous role in popularizing this approach.
The following principles are followed while performing microsurgery:
~ Careful patient selection.
~ Developing a good preoperative plan as well as a backup plan.
~ Use of a well-defined 'workhorse' flap.
~ Patient consent after explaining all details.
~ A meticulous microsurgery technique during operation.
~ Vigilant postoperative care.