atlas of microsurgery techniques and principles

Microsurgery Definition

What is microsurgery?

Microsurgery is a surgical discipline that combines magnification with advanced diploscopes, specialized precision tools and various operating techniques. These techniques are primarily used to anastomose small blood vessels (arteries and veins) and to coapt nerves. Microvascular and microneural coaptation allow for complex repair of human tissue after trauma, cancer and congenital deficiencies. Two of the main purposes of microsurgery are to transplant tissue from one part of the body to another and to reattach amputated parts. It is incorrect to state that microsugery is simply a general term for surgery requiring an operating microscope. This loose definition does not convey the breadth and complexity of the specialty. Yes, microsurgeons use microscopes, but that is a small part of what the specialty addresses. In fact, microsurgery encompasses much, much more than this simple definition. The procedures themselves are a mixture of surgical science and art and take many years of training to become proficient.
Microsurgery helps to heal wounds, restore function after trauma, and restore form after cancer. It can assist in the recovery and healing of a wide array of medical issues, from emergency amputations to reconstoration of the human breast.
The microscope:
The microscope itself has two binocular viewing fields (a diploscope). This allows a surgeon and assistant to perform surgical techniques under magnification from 4 to 40 times power. This allows visualization of small structures, such as arteries, veins, nerves and lymphatics. Visualization of these structures allows them to be surgically manipulated, enabling the microsurgeon to:

    Reattach amputated body parts (replantation)
    Transplant tissue from one part of the body to another (microvascular transplantation)
    Repair nerves
    Repair blood vessels
    Manage complex soft tissue and bone infections
Overview image:
Performing microsurgery: Two teams of microsurgeons using operating diploscopes (binocular viewing fields). Photo: Walter Lin, MD. The Buncke Clinic.
microsurgeons performing microsurgery operating with microscopes
Microscope view:
Microsurgery: A view from under the microscope of a lymphovenous anastomosis. The grid is 1 mm. Bluish dye in the vessel is isosulfan blue mixed with lymphatic fluid.
microsurgery: lymphovenous anastomosis under magnification

More definitions

Free flap:
Tissue isolated on a vascular pedicle and transplanted from one part of the bod to another. Also known as a microvascular transplant (our favored term, because of its precision) or free tissue transfer.
Microvascular transplant:
Tissue isolated on a vascular pedicle and transplanted from one part of the bod to another. Also known as a free flap or free tissue transfer.
Free tissue transfer:
Tissue isolated on a vascular pedicle and transplanted from one part of the body to another. The term is imprecise since it does not convey the necessity for microsurgery, and may imply moving tissue without vascular repair. For instance, a skin graft does not require micorusrgery yet could be considered a free tissue transfer. A pollicization of the thumb from the index finger requires the tranfer of the index ray to the thumb position. A transfer implies moving from one place to another, such as index to thumb, but does not necessitate removal from the original location. A transplant on the other hand, reflecs removal from the original location, and placement at another part of the body with vascular repair.
An operating microscope with separate binocular fields, one for the surgeon and one for the assistant.