Microsurgery in Replantation

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January 14, 2013
Edward Smith

Microsurgery is one of the latest types of surgery to develop. It involves doing surgery to blood vessels and nerves underneath a microscope. It is the type of surgery that makes doing replantation of amputated body parts possible. Vessels and nerves of around one millimeter in diameter have been reattached successfully. Microsurgery is used in trauma surgery as well as in plastic surgery, general surgery, ophthalmology, orthopedic surgery, neurosurgery, pediatric surgery, maxillofacial surgery, and otolaryngology.

Microsurgery was first used by otolaryngologists in about 1921. The first monocular surgical microscope was built and was eventually used in people who had fistulae. Binocular microscopes were then used starting in 1922. Other ear operations were done using a binocular microscope soon after.

In today’s time, neurosurgeons use microsurgery to do their surgeries and trauma surgeons use it to replant limbs or parts of limbs that have been torn or cut away from the regular tissue. In neurosurgery, the first surgeon to use microsurgery was a doctor, Gazi Yasargil, who used microsurgery to do brain and external nerve injury in the 1950s. He went on to publish a four volume set of his life’s work, entitled, Microneurosurgery. Vascular microsurgery was popularized in the 1960s where blood vessels as small as 1.4 millimeters were connected to one another. The first partial digital amputation was replanted using microsurgery in 1963.

Free tissue surgery was used in Japan to connect esophageal portions to the neck of the patient using vessels as small as 3-4 millimeters and following cancer resection surgery.

Now, many subspecialties use microsurgical techniques as part of their day to day surgery. Besides trauma surgery, head and neck surgeons do inner ear and vocal cord surgery using microsurgery. Oral and maxillofacial surgeons use these same techniques to reconstruct facial defects following significant head and neck surgery. Ophthalmologists use microsurgery to do cataract surgery, to treat glaucoma and to do corneal transplants. Urologists reverse vasectomies or reverse tubal ligations in order to restore a person’s fertility.

In one recent study, the researchers identified ways to perform a microsurgical replantation of a severed limb. The authors recommended using the superficial temporal arteries when they aren’t damaged at all so that the replantation surgery can be easier and the vessels are basically transplanted to where they are needed in the body. They’ve identified a technique known as the Kunlin’s technique that helps the surgeon connect two vessels of different sizes. They also recommend removing the posterior epithelial layer of skin to allow for drainage of the veins in the replanted ear so that the ear can drain itself of fluid and a cauliflower ear doesn’t develop. It can also help the doctor keep the replanted part of the body immobile.
Without microsurgery, replantation might not get done successfully and important body parts will suffer from necrosis and tissue loss. When the doctor can put together the large and small vessels equally, the chances of a successful transplantation/replantation procedure will be much higher.