Microsurgery is a surgical technique in which a microscope or high-powered magnifying tool is used to provide precision during complex operations on small vessels and nerves. During procedures on the breast and hand, particularly those involving free tissue transfer, replantation or transplantation, microsurgery is used to anastomose, or connect, blood vessels, veins and nerves.
Free tissue transfer is used in a number of reconstructive procedures, including breast reconstruction, and involves transferring of tissue grafts called flaps, along with their blood supply, to the wound site. During free tissue transfers, blood vessels and veins are reconnected to the graft recipient site, an innovative procedure that is possible thanks to microsurgery. The flap itself consists of fat, skin, blood vessels and muscles, and serves as the tissue used to recreate the breast mound.
Replantation is conducted during hand surgery to reattach an amputated finger or other body part, also using microsurgery to anastomose veins, vessels and nerves. Tendons and bones are reconnected using other techniques. When an amputated finger cannot be reattached, transplantation is conducted using microsurgery to transplant tissue from other parts of the patient’s body.
Who can be helped with Microsurgery?
Indications for microsurgery are determined by the loss of shape and function in the breast or hand, and the corresponding need to conduct a free flap during breast reconstruction, or transplantation/replantation during hand reconstruction.
Microsurgery can be indicated for breast and hand procedures with patients who demonstrate a need to restore shape, such as in breast reconstruction after mastectomy, or to restore function, as in the transplantation or replantation of traumatized fingers of the hand.
How Does it Work?
Because of the intricacy of anastomosis, microsurgery often takes several hours to conduct, and is performed in a hospital setting.
First, our plastic surgeon, Dr. Neal Goldberg, will complete the surgical steps involved in reconstruction leading up to the time when microsurgery is needed. After identifying and exposing the blood vessels requiring microsurgery, the surgeon increases magnification in order to connect the vessels of the graft with the vessels at the recipient site. In the case of hand surgery, fractured or severed bones are treated first. Next, anastomosis of the veins is completed, followed by tendon and nerve repair, and finally soft tissues.
Free flaps are implemented during breast surgery when tissue is disconnected from its blood source at the donor site in order to be transferred to the recipient, or wound, site. Using microsurgery the surgeon then connects the blood vessels so that the wound site can receive the new tissue. Dr. Goldberg may use a piece of contrast material, placing it behind the vessel to increase perception. Once successful anastomosis has been confirmed, the surgeon works to ensure that the blood vessels are relaxed, and are not knotted or kinked with tension.
Recovery from Microsurgery
If you have undergone microsurgery you will be monitored in an inpatient setting immediately following surgery. Upon being discharged, you will receive explicit aftercare instructions on how to recover successfully. You may be asked to remain on bed rest for days or weeks after surgery. Rehabilitation may be recommend in order to promote circulation.
Dr. Goldberg treats patients from Scarsdale, Dobbs Ferry, Yonkers and many other communities. For more information about Microsurgery, call our office for a consultation at 914-840-5999.