Microvascular surgery involves using an operating microscope, specialized surgical instruments and tiny needles with ultrafine sutures to reattach severed hands, arms, fingers and other amputated parts to the body. During surgery, small blood vessels are reconnected to restore circulation before the injured tissue begins to die.
Types of Microvascular Surgery
Types of microvascular surgery include:
- Breast Reconstruction
- Superior and inferior gluteal flap
- TFL flap
- Gracilis flap
- Ruben’s flap
- Trunk
- Abdomen and chest (for large wounds caused by cancer surgery and radiation therapy)
- Head and Neck Reconstruction
- Jaw or jawbone (mandible)
- Esophagus
- Scalp
- Cranial base
- Legs (Lower Extremities)
- Traumatic wounds
- Post-cancer surgery
- Salvage of amputation stumps
- Bony reconstruction
- Non-healing lower extremity ulcers secondary to diabetes
- Arterial or venous insufficiency
- Facial Re-Animation Surgery
- Restoration of facial expression following nerve injury or cancer surgery
- Hand
- Wounds
- Digital replacement and reconstruction
- Transplantation of functioning muscle
Who Needs Microvascular Surgery
Cancer, trauma and congenital disorders may alter or destroy various parts of the body, causing difficulty in breathing, chewing, swallowing or making other bodily movements. For patients who have undergone cancer surgery or experienced severe traumas, microvascular surgery involves taking tissue (bone, muscle and/or skin) from one part of the body and transplanting it to the affected area.
The transplanted tissue is connected to small blood vessels under a microscope so that it becomes living tissue with its own blood supply right away. The complexity of the procedure will depend on the type of injury and location of the injury.
Before the procedure can be performed, the medical team will examine the patient and develop an appropriate treatment plan that takes into consideration the disease, other medical conditions and the aesthetic and functional goals.
Side Effects and Risks
The risks of microvascular surgery include:
- Bleeding
- Infection
- Poor healing of incisions
- Hematoma
- Anesthesia risks
- Fluid accumulation (seroma)
- Skin loss or tissue necrosis
- Numbness or other changes in skin sensation
- Skin discoloration and/or prolonged swelling
- Persistent pain
- Scarring
- Unsatisfactory aesthetic result
- Recurrent looseness of skin
- Fatty tissue found deep in the skin might die (fat necrosis)
- Deep vein thrombosis, cardiac and pulmonary complications
- Asymmetry
- Possibility of revisional surgery
After the Procedure
Patients will have gauze dressings and bandages applied to their incisions. In addition, an elastic bandage or compression garment will be provided to help minimize swelling and support the donor site.
The patient’s blood flow will be closely monitored in a hospital setting and small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood.
After the procedure, the patient will receive specific instructions detailing:
- How to care for the surgical site(s)
- Concerns to be aware of
- Medications to take orally or apply topically
- Activity restrictions
- Follow-up dates
Patients should ask their surgeon the following questions:
- Where will I be taken once the surgery is finished?
- What medication will I need to take after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Will there be drains and for how long?
- How soon can I bathe or shower?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?