Microsurgery

What is Microsurgery?

Microsurgery is a surgical technique used to repair, reattach, or transfer tissues. The surgery is performed under a high-powered microscope using very fine instruments and small sutures. Small blood vessels or nerves, typically 1-3mm in diameter but often even smaller, are worked on during microsurgery. The magnification of the microscope allows surgeons to connect these structures with precision that would not otherwise be possible.

When Would I Need Microsurgery?

Microsurgery is utilized as a technique in many procedures including free tissue transfer (free flap), nerve repair or transfer, reattachment or replantation of amputated body parts, and lymphedema surgery.

Free tissue transfer, or a free flap, can be thought of as a transplantation of tissue. Skin, fat, muscle, bone, or a combination of these, can be moved from one area of the body to another. The small blood vessels are reconnected in the new area to keep the tissues alive. The tissues are supplied with blood and go on to heal in the new area of the body. Free flaps are most often used to reconstruct body parts after cancer or trauma. Examples of traumatic injuries that would require a free flap are injuries that involve loss of large amounts of skin and soft tissue such as after a car accident or industrial/machine accident.

What Surgeons Perform Microsurgery?

Microsurgery is performed by hand surgeons, orthopedic surgeons, plastic surgeons, nerve surgeons, and otolaryngologists. It requires specialized training. It is important to see a specialist when looking for a surgeon to perform these procedures. Because of the equipment required, longer operative time, and frequent requirement for overnight stay, these procedures are usually performed in a hospital setting under general anesthesia.

How Do I Prepare for Microsurgery?

Procedures containing microsurgery can often be lengthy operations. Your surgeon will discuss what is required to prepare for these surgeries. Often, you will be asked to get bloodwork done. Depending on your age and other medical problems, you may need an EKG, chest X-ray, or workup from a cardiologist. It is important to stop smoking 3-4 weeks prior to your surgery and refrain from smoking for 3-4 weeks after surgery. Some of your medications may also be changed. Finally, a balanced diet and regular exercise prior to surgery is always beneficial to promoting recovery.

What Can I Expect After Microsurgery?

Your recovery after a microsurgical procedure will vary depending on your condition. Some procedures can be done in an outpatient setting. Examples of outpatient procedures would be nerve transfers or nerve repair. Surgeries requiring the connection of blood vessels, such as free flaps or reattachment of body parts, will likely require a hospital stay. The length of stay will be determined by the type of procedure. The hospital stay may include admission to the ICU or a specialized surgical unit for closer monitoring.

The first day after your procedure, you may be monitored as often as every hour to make sure the transferred tissue or the reattached body part continues to have good blood flow. These checks will become less frequent over the course of your hospital stay. Your surgeon will ask you to refrain from smoking or using nicotine-containing products since these products can affect blood flow and healing. Surgeons may prescribe additional medications or use warming devices to help with blood circulation.

Return to work or regular activities will vary depending on the procedure. Ask your hand surgeon if you have additional questions about recovery.