Definition and Overview

Microvascular surgery is a subspecialty of microsurgery and involves performing surgical procedures on tiny blood vessels, ranging from three to five millimeters in diameter. These tiny blood vessels, formerly considered too delicate for traditional surgical techniques, can be operated on using a microscope specially designed for operating room use. Microvascular surgeons also use specialized instruments, such as very small needles that can produce very fine stitches.

Microvascular surgery is often used for replantation, or the surgical reattachment of fingers, arms, hands, and other such parts that were completely cut off from the body. These body parts are especially tricky to reattach, since they have a network of small blood vessels that need to be reconnected back to the body. Aside from replantation, microvascular surgery can also be used for reconstructive surgery (as a way to restore form and function of injury- or illness-damaged body parts), grafting veins, repairing nerves, and repairing blood vessels.

Who Should Undergo and Expected Results

People suffering from the following conditions are ideal candidates for microvascular surgery:

  • Illnesses that has damaged certain parts of the body (including cancer and other diseases that affect tissues, muscles, and blood vessels)
  • Traumatic tissue loss
  • Congenital tissue absence
  • Have completely detached body parts (including fingers, thumbs, arms, ears, scalp, nose, and genitalia)
  • People with infertility issues caused by obstructions in key passageways

How is the Procedure Performed?

The methods and techniques used in performing the procedure depend on the circumstances of the patient needing the microvascular surgery. If the patient is brought in because of an emergency (such as crushing injuries or amputation), the surgeon must work quickly to ensure that the reconstructive or replantation surgery will be successful. The patient must immediately undergo an x-ray to determine the extent of the injury. In the case of amputation, extreme care must be taken to preserve the tissues of the amputated body part.

Microvascular surgery for chronic conditions can follow a less time-sensitive procedure. The patient will be advised to refrain from habits that can hinder healing (such as smoking and taking certain types of medication).

For the surgery itself, the patient will be placed under general anesthesia. Since microvascular surgery is quite complex and done under a microscope, the procedure can take up to twelve hours or more. Aside from an operating room microscope, the surgeon will also use a variety of specialized tools that can repair and reconstruct blood vessels and tissues precisely.

After the procedure, the patient will be hooked up to an IV line for 12 to 24 hours. The patient will be on a liquid diet before being allowed to eat solid food. Several imaging and diagnostic tests will be performed on the patient to determine whether the procedure has been successful. These tests can include an arteriography, a Doppler ultrasound, and a pulse oximetry test.

When the patient is allowed to go home from the hospital, he or she will need to stay away from tobacco smoke and nicotine for at least six weeks. The patient might also need to undergo physical rehabilitation after the surgery wounds have healed.

Possible Risks and Complications

Infection is one of the major risks or complications of microvascular surgery, especially in the case of replantation. Other possible complications are:

  • Adverse reactions or allergy to anesthesia
  • Blood clots in the blood vessels
  • Tissue necrosis
  • Pulmonary embolism
  • Deep vein thrombosis
    Reference:

  • UCLA Health: “Microvascular and Reconstructive Surgery”

  • Plastic Reconstructive Surgery: “A Clinical Extension of Microvascular Techniques”
  • University of Florida Health: “Microvascular Surgery for Breast Reconstruction”
  • American Society for Reconstructive Microsurgery
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