Microsurgery Health Article

Diagnosis/Preparation

In an emergency situation, such as an amputation or crushing injury, a number of steps must be taken immediately to improve the odds that replantation or reconstruction will be successful. An IV line is placed so that fluids and antibiotics can be administered. The injured area is x rayed so that the extent of the injury can be determined, and the amputated body part is wrapped in sterile gauze and placed on ice, so that the tissues are preserved. To prevent freezing, the body part must not be packed below the ice. The patient is transported by ambulance or helicopter to the nearest surgical center capable of microsurgical repair.

In other cases, a patient may suffer from a chronic condition or wound, and microsurgery can be scheduled as an elective procedure. Prior to surgery, the patient will be instructed to refrain from tobacco use because it interferes with healing. In addition, the patient will be told not to eat after midnight the day of surgery. It is important that the patient inform the doctor completely about any prior surgeries, medical conditions, or medications taken on a regular basis, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin. Patients taking blood thinners, such as Coumadin or Heparin (generic name: warfarin), should not adjust their medication themselves, but should speak with their prescribing doctors regarding their upcoming surgery). Patients should never adjust dosage without their doctors' approval. This is especially important for elderly patients, asthmatics, those with hypertension, or those who are on ACE inhibitors.

The patient will be placed under general anesthesia for the duration of the procedure. The advantages to general anesthesia are that the patient remains unconscious and completely relaxed during the procedure, imperative because of the precise nature and extended duration of the surgery. The patient must be able to tolerate the long surgery and therefore must be relatively stable condition; complex surgeries may take up to 12 hours or more.

Microsurgery makes possible a number of reconstructive procedures that would be more difficult or impossible with conventional surgery. Some of the more frequently performed microsurgical procedures include:

• Replantation. This emergency surgery is performed to reattach an amputated body part such as a finger, arm, or foot. Replantation surgery requires a series of time- and energy-intensive steps to reattach all of the structures while the amputated part is still viable. The cut bone must be shortened slightly so that blood vessels and nerves can be reattached without tension. Anastomoses are created between cut arteries and veins and blood flow is reestablished to the amputated part. Tendons (if present) are then repaired, followed by nerves and soft tissues. Further procedures may be necessary to completely the reconstruction depending on the extent of the injury.
• Transplantation. In some cases an amputated part cannot be reattached, or tissue is deformed because of a congenital defect or an injury. Transplantation may then be an option. The great toe or second toe may be removed from a patient's foot and transplanted to the hand to replace a missing finger. A segment of rib along with its blood supply can be used to reconstruct bones in the face and jaw.
• Free-tissue transfers. Also called free flaps, free-tissue transfers may be used to reconstruct damaged tissues that cannot be treated with skin grafts, closed by traditional methods such as suturing, or allowed to heal without intervention. This includes tissues that have constricted after a burn, injuries in which there is not sufficient skin to properly close the wound, or tissues that have been removed as a result of treatment for cancer. Examples of tissues that may be transferred with
  microsurgical techniques are skin, muscle, fat, bone, and intestine.