Microsurgery is a highly specialized surgical technique that uses operating microscopes with magnification up to 40x and miniaturized instruments to perform procedures on submillimetric anatomical structures: blood vessels, nerves, lymphatic vessels, and ducts. It represents one of the most advanced competencies in reconstructive plastic surgery, enabling replantation of amputated segments, tissue transfers from one part of the body to another (free flaps), and complex reconstructions otherwise impossible.
Using high-precision operating microscopes and dedicated instruments (microsurgical forceps, scissors, needle holders, and suture threads thinner than a hair, gauge 9/0-11/0), the plastic surgeon reconnects blood vessels and nerves with diameters even smaller than a millimeter. Vascular anastomoses (arterial and venous connections) ensure blood supply to the transferred tissue, while nerve sutures allow recovery of sensitivity and motor function. The required precision is extreme: each suture point is placed under microscopic vision with micron-controlled movements.
• Replantation of traumatically amputated limbs or fingers, when segment conditions and ischemia time allow • Free flaps for complex reconstructions: transfer of tissues (skin, muscle, bone, fat) from donor sites to reconstruct extensive defects after trauma, tumors, or malformations • Breast reconstruction with DIEP flap, the most advanced technique using abdominal tissue with microsurgical vascularization • Chronic limb lymphedema, through lymphatic-venous anastomoses or vascularized lymph node transfer • Facial paralysis, through transfer of vascularized and innervated muscles to restore facial movement
• Severe vasculopathies (advanced atherosclerosis, vasculitis) that compromise the quality of blood vessels available for microsurgical anastomoses • Active smoking, which significantly compromises microcirculation and increases the risk of anastomosis thrombosis. Smoking cessation at least 4-6 weeks before surgery is essential • Uncontrolled coagulopathies or anticoagulant therapies that cannot be managed perioperatively • General conditions that do not allow prolonged surgical procedures under general anesthesia • Poorly controlled diabetes, which impairs healing and microcirculation
Microsurgical procedure duration varies considerably based on complexity: a finger replantation takes 3-6 hours, a free flap for lower limb reconstruction 4-8 hours, while breast reconstruction with DIEP takes 5-8 hours. For complex replantations (hand, forearm), duration can reach 10-12 hours. Hospital stay is 5-10 days with intensive monitoring of the transferred or replanted tissue vascularization in the first 48-72 hours. Full recovery requires weeks or months with dedicated rehabilitation.
Yes, microsurgery is always performed under general anesthesia, given the duration and complexity of the procedures. The anesthesiology team plays a fundamental role in maintaining optimal hemodynamic conditions for tissue perfusion: stable blood pressure, adequate blood volume, and appropriate body temperature are essential for microsurgical anastomosis success. Postoperatively, anticoagulant and vasodilator therapy is established to protect the anastomoses.
Microsurgery results develop over different timeframes. The viability of transferred or replanted tissue is verifiable in the first hours and days (color, temperature, capillary bleeding). Functional results, particularly recovery of sensitivity and motor function, require months and sometimes years to reach their maximum, as nerve regeneration proceeds at approximately 1 mm per day. Physical rehabilitation is fundamental to optimize functional recovery.
Microsurgery enables replantation of fingers (single or multiple), hands, forearms, ears, scalp, and other traumatically amputated segments. Replantation success depends on several critical factors: ischemia time (the segment must be properly preserved on ice and reach the operating room as quickly as possible), the mechanism of amputation (clean amputations have a better prognosis than crush or avulsion injuries), and the patient's general condition. It is essential that the amputated segment be wrapped in moist gauze, placed in a bag, and kept on ice without direct contact.
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