Our clinical program in reconstructive microsurgery offers truly state-of-the-art care for some of the most clinically vexing problems that, until recently, were virtually unsolvable.
Microsurgery involves magnifying the visual field of surgeons to enable them to see better, dissect better and perform micro-manipulation. This magnification helps them to perform very precise surgery that was not possible in the past. The greatest impact of microsurgery has been in our ability to suture small blood vessels and nerves, thus making it possible to transplant tissues from one part of the body to another.
Reconstructive surgery using microsurgical techniques is known as "spare parts surgery" because body tissues consisting
either singly or in combination of a patient's own toes, digits,
bone, cartilage, skin, muscle, intestine and other organs are used
Microsurgery first drew clinical attention in the late 1960s and early 1970s when it was used mainly as a tool to assist with the reattachment of severed fingers and limbs. The dissecting microscope provided a means of visualizing and repairing injured small blood vessels and nerves. Its use in general reconstructive surgery soon followed.
Plastic surgeons learned that they could sever the blood vessels supplying a chosen donor tissue, and transfer it to a "distant" site where it was needed to solve a reconstructive problem. This new modality rendered many previous multi-stage procedures obsolete, and in many instances provided reconstructive options where none before existed.
Although a relatively new form of surgery, reconstructive microsurgery is now widely accepted. Over the last three decades more than 100 donor "flaps" — pieces of tissue completely severed from their place of origin that are transplanted to a new site to reconstruct a tumor defect — have been described, and a nationwide success rate of over 90% has been realized.
L.T. (age 24) was riding in a car with his fiancée when he noted an unusual sound emanating from his back tires. He pulled the car to the side of the road to investigate the problem. While examining the back tire on the driver side of his vehicle, he was struck by an oncoming car. The impact severed his left leg below the knee.
He was rushed by helicopter to University Hospital where an immediate plastic surgery consultation with us was sought to determine if the amputated part could be reattached. Since there were extensive injuries to the amputated leg, reattachment was not considered possible.
Assessment of the amputation stump showed marked injury to muscle tissue as well as exposed bone. Unless healthy tissue could be transferred to the site of injury the amputation level would have to be raised above the knee, sacrificing an important lower extremity joint and limiting the patient's ultimate level of rehabilitation.
Although several muscles from the patient's body could have been used as donor tissue, we decided to utilize tissue from the amputated part. The sole of the foot was removed from the amputated part and transferred to the amputation stump with the aid of the microscope. All operative sites healed well, and the patient's knee joint was preserved, allowing him to walk well with an artificial leg.
B.L. (age 39) was involved in an accident while riding a motorcycle with her husband. Both of her legs were broken. She was airlifted to University Hospital. Her husband was also brought here, but died two hours later from massive injuries.
She had a severe soft tissue avulsion over an open fracture of her left lower leg, which a few years ago would have necessitated amputation. Six days after her admission, she underwent a seven- hour procedure to transplant a muscle from her back to her leg, providing coverage of all exposed vital structures. All operative sites healed well.
She did exceptionally well in rehabilitation. Furthermore, as an expression of gratitude for the care she received, she helped other patients undergoing reconstructive microsurgery at University Hospital and Medical Center, giving them the moral support they need before and after surgery.
New Possibilities for Therapy
Reconstructive microsurgery offers a wide range of therapeutic possibilities. Injuries to limbs that previously could only be treated by amputation can now be successfully treated and the limbs reconstructed with functional results. Malignancies that are limb- or life-threatening after surgical extirpation no longer need be so.
Malignancies resulting in the loss of the cervical portion of the esophagus can now be reconstructed with transplantation of a portion of the patient's own small intestine. Even reconstruction of the breast can be enhanced via microsurgical techniques. Lost digits can be reconstructed with toe-to-hand transfers, even years after their loss. And burn reconstruction can be made more functional and aesthetically appealing.
The increasing application of microsurgical techniques is currently
being seen more and more in limb preservation surgery for trauma,
tumor resection, congenital abnormality and organ transplant.
In sum, the advent of microsurgery has been one of the most important developments in modern surgery, and it has made possible rapid, major advances in the field of plastic and reconstructive surgery.