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Microsurgical techniques combine the use of magnification with specialized operating tools to perform certain surgical procedures
Microsurgical techniques combine the use of magnification with specialized operating tools to perform certain surgical procedures. Microscopes allow surgeons to examine structures such as small blood vessels, lymph vessels, and nerve fibers that are barely visible to the naked eye and manipulate them with greater precision.
Microsurgical techniques typically use a diploscope, which is an operating microscope with two binocular fields—one for the surgeon and the other for the assistant. Dyes may be used to further highlight the structure being operated on.
What are examples of microsurgical techniques?
Examples of microsurgical techniques include:
- Toe or finger transplantation
- Head and neck reconstruction
- Breast reconstruction
- Bone flap transfer
- Nerve repair and grafting
- Free muscle transfer to treat some types of muscle paralysis such as facial paralysis with muscular atrophy
- Lymphatic reconstruction
- Esophageal reconstruction
- Wound reconstruction
- Some types of infertility treatments such as tubal repair, varicocele treatment, or removal of obstructions from the vas deferens
- Ear, nose, or scalp repair
- Various eye surgeries
- Gender affirming surgery
When should microsurgery be avoided?
Microsurgery must be avoided in the following situations:
- Issues concerning the patient: Certain health conditions may put the patient at a higher risk of complications, including procedure failure or danger to the patient’s life.
- Microsurgery must be avoided if the patient has following conditions:
- Severe respiratory disease
- Ongoing sepsis (a serious and life-threatening type of infection that is associated with multiple organ dysfunction)
- Coagulopathy (uncontrolled bleeding or clotting disorder)
- Although not absolute, microsurgery may be avoided in some other health conditions such as:
- Kidney disease
- Peripheral vascular disease
- Diabetes mellitus
- Cardiovascular disease
- Raynaud’s disease
- Collagen vascular diseases such as scleroderma
- Active infection
- Smoking
- Radiation
- Issues concerning the surgery: Microsurgery is a complicated procedure that requires considerable expertise and experience. Microsurgical techniques should be avoided if:
- The surgeon or their team lacks enough experience or skill to perform the procedure.
- Appropriate resources for the care of the patient during and after the surgery are not available.
- Proper microsurgical instruments are not available.
- Microsurgery must be avoided if the patient has following conditions:
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What are the risks of microsurgery?
Microsurgery is generally a safe procedure when done by an experienced surgical team in a well-equipped hospital setting. Nonetheless, every procedure carries some risks. Possible complications that may result from a microsurgical procedure include:
- Bleeding or hematoma formation (collection of blood in the tissues) that may require a blood transfusion
- Infection or sepsis
- Flap compromise (failure of flap to thrive) due to vein or artery thrombosis (blockage of a blood vessel by a clot)
- Flap congestion (pooling of blood in the tissue flap)
- Fat necrosis (death of cells in the flap)
- Wound breakdown or dehiscence
- Complications related to anesthesia
- Deep vein thrombosis (presence of a blood clot in deep veins, such as the veins in the legs)
- Wound complications at the donor site (the site from where the flap is harvested)
- Pulmonary embolism (a condition in which one or more arteries in the lungs become blocked due to a clot)
