Definition & Overview

Microsurgery is a procedure performed on parts of the body that require a microscope to be viewed and operated on. These include small blood vessels, nerves, and tubes. Microsurgery is typically performed on the areas of the ear, nose, and throat because these have small and delicate structures. The procedure, which uses an operating room microscope or a high-powered loupe magnification, is usually not the first option for the treatment of reconstructive problems, but it can be used to fix complex reconstructive issues in place of other procedures such as primary closure, skin grafting, healing by secondary intention, or local and regional flap transfer.

The history of microsurgery all began when the operating microscope was first introduced and, with it, the first descriptions of blood anastomosis of the blood vessels were made. By the 1960s, microsurgical techniques were becoming more popular, and in 1964, a rabbit’s ear was replanted through a microsurgical procedure, which was a remarkable first because the blood vessels involved in the procedure were as small as 0.1 cm. After two years, a monkey received a surgery that attached a toe to its hand, proving once again the value of microsurgery to modern medicine. The success of the procedure was further strengthened by the increasing prominence of digital artery repairs and finger replantation. Because of the success that the procedure had during the 1960s, the microsurgical composite tissue transfer became popular in the 1970s. During the next decade, a mandibular reconstruction procedure for cancer called autologous tissue transplantation was introduced. The success of the procedure over the years has made microsurgery a very important procedure in plastic surgery.

Who Should Undergo & Expected Results

Microsurgery is a procedure performed on small parts of the body using a microscope. It can be used to treat eye problems such as cataracts and glaucoma as well as in performing vasectomies and tubal ligations. Plastic surgery also now heavily relies on microsurgery for the reconstruction of damaged skin, muscles, and tissues, and it is also very helpful in the reattachment or replantation of amputated body parts.

Most importantly, microsurgery has now become a vital procedure in the field of neurosurgery, and in the treatment of cancerous tumours as well as vascular abnormalities found in the brain.

Thus, people who should undergo the procedure are those who need the following surgery or treatment:

  • Reattachment of an amputated body part
  • Surgery involving the ear, nose, and throat
  • Plastic surgery
  • Cataract surgery
  • Vasectomy
  • Tubal ligation
  • Treatment or surgical removal of cancerous tumor
  • Reconstructive surgery involving the skin and muscles

After the surgery, patients are given intravenous fluids and placed on a liquid diet for about 12 to 24 hours. They are also advised to take a lot of caution and rest and provided round-the-clock assistance or care. The surgery also requires patients to keep warm and to stay properly hydrated following the procedure. Most importantly, the area of the body, where the surgery was performed, must be kept in an elevated position so that the excess fluids would drain properly. Some pain may be expected after the surgery, but this is easily managed with pain medications.

As a result of the surgery, the skin in the part of the body operated on might feel warm and become flushed or reddish. The area must be closely observed and any changes in its color, temperature, capillary refill, and tissue turgor or fullness must be reported to the doctor.

How Does the Procedure Work?

The equipment used for a microsurgery helps magnify the operating field and allows precision in movement despite the high magnification. The magnification allows for operation of structures that are otherwise very hard to see because of their microscopic size. The tools most vital to a microsurgery are the microscope, microsurgical instruments, and a microscopic mat. Operating microscopes are usually different from one another because each has its own intended use and features. Some microscopes are stand-alone while some are ceiling-mounted; each one is equipped with a moveable arm that makes it possible for the surgeon to change the microscope’s position.

Due to its complexity and the special nature of this type of surgery, several considerations have to be made and several factors that are not necessary in a conventional surgery are introduced. The surgical sites, given their size, can be viewed only because of the special set of lenses of the microscope and the high-intensity light source used during the procedure. The operating room is also set with a low lighting so that the lighting of the microscope is enhanced. The surgical team also has a video camera that displays a view of what is happening in the operating field. Further, the magnification that is normally required for microsurgery is about five to forty times. For identifying and exposing structures, lower magnification is used. For microsurgical repair, an even higher magnification is often required. Lower magnifications (about two to six times) use surgical loupes or magnifying lenses that are placed on a pair of eyeglasses.

The different microsurgical instruments used for microsurgery are specially designed. These instruments are made capable of maneuvering even microscopic structures within the body. Some instruments used in microsurgery include the following:

  • Forceps
  • Needle holders
  • Scissors
  • Vascular clamps used to control bleeding
  • Clamp applicators
  • Irrigators used for washing
  • Vessel dilators used to open up the cut of a blood vessel
  • Standard surgical tools

Specialized threads and needles are used for suturing and stitching. Each suture thread used for this procedure has a size that depends on the kind of procedure it is used for. The normal suturing thread has a diameter of 2-0 (0.3 mm) to 6-0 (0.07 mm). The suture thread may either be absorbable, non-absorbable, natural, or synthetic. The absorbable suture can stay in the body for a specific amount of time and can be broken down, while the non-absorbable is capable of maintaining its strength. The natural suture threads are made of silk, gut, and linen. Synthetic suture threads are made of nylon, polyester, or wire.

Possible Risks and Complications

All surgeries have risks particularly those that are complex and involve microscopic body parts. Microsurgery may cause the following complications and risks:

  • Flap congestion
  • Fat necrosis
  • Hematoma
  • Infection
  • Wound breakdown/complication
  • Systemic complications associated with anesthesia
  • Deep vein thrombosis and pulmonary embolism

Patients should discuss the procedure in detail with their surgeon or attending physician to understand not just its benefits but also possible risks and complications.

References:

  • The Microsurgery Training and Research Laboratory
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