Microvascular surgery is one of the new advancements in the field of medicine and surgery which requires skilled surgeons who are well trained and experienced to perform the procedure.
Microvascular surgery also commonly referred to microvascular reconstructive surgery as it is mainly indicated for the repair of large surgical defects with the help of using surgical grafts from either muscle, bone, skin, fat along with use of blood vessel suturing to aid in the healing of the surgical area. Microvascular surgery is a rather new technique which is used for reconstruction of extensive surgical defects.
Microvascular surgery is done on very minute blood vessels, characteristically 3 to 5 millimeters in diameter, using specialized armamentarium. This armamentarium includes a special operating microscope, minute surgical instruments, and small needles with ultra-fine sutures. The surgery is performed under optical magnification in vessels with a diameter of less than 3 mm. Micro-anastomosis or joining of minute vessels with a caliber between 1 and 2 mm, is the basis of modern microvascular practice. Since then, several types of microvascular tissue transfer techniques for the repair of large body defects have been developed, accompanied by significant advances in optical imaging technologies and instrument design.
What is the purpose of microvascular surgery ?
A microvascular surgery is advised in patients who have suffered extensive tissue trauma because of the above mentioned causes or diseases and the surgical defect is greater and needs to be treated by the incorporation of a surgical graft. Microvascular surgery is indicated for the reconstruction of large surgical defects which are could be caused due to the below mentioned conditions.
- Trauma to the face, head and neck region, arms
- Cancer which was surgically removed leaving a visible defect
- Osteoradionecrosis (a side effect of radiation therapy to the head and neck)
- Extensive bone infection of the jaws: osteomyelitis
- Oroantral fistula (an opening between the oral and the sinus cavities leading to complications)
- Trismus
- Congenital defects
As mentioned earlier microvascular surgeries are recently gaining importance in the reconstruction of large surgical defects, the technique is mostly applied for the reconstruction of defects occurring in the head and neck region.
Microvascular surgery can be used to reposition and attach severed or detached amputated parts of the body like fingers, hands and arms. This is done by reconnecting and joining the minute blood vessels, therefore restoring circulation before the injured tissue dies or necroses. Microvascular surgery is also of use in reconstructive surgery. It gives the reconstructive surgeon a key tool to attain complex reconstruction by arranging free tissue transfer from distant sites. Free tissue transfer includes flaps such as isolated transfers, composite tissue transfers, functioning free muscle transfers, vascularized bone grafts, and toe transplantation. Additionally, specific tissue transfers like neural grafts or vein grafts are also thought to be free tissue transfer. Even in large defects of the face after tumor resection or breast defects, free tissue transfer may be the paramount option for closure of the defect.
In reconstructed tissue, transplanted healthy tissue from a distant site (also called “free flap”) is sutured into its new position. This healthy tissue is then joined to the site of the wound where the blood circulation is restored. Even though microsurgery is used primarily in plastic surgery, it is now finding diverse applications in the fields of general surgery, otolaryngology, neurosurgery, orthopedic surgery, gynecologic surgery, maxillofacial surgery, and even pediatric surgery.
It is important to consult you treating specialist to see if microvascular surgery can be a suitable treatment for you. The consultant specialist will do a complete general physical examination and examination of the site which needs to be reconstructed. A number of tests to determine overall health may be performed as a microvascular surgery is a major surgical procedure. The investigations may include cardiac and pulmonary examination, imaging studies such as CT scan, MRI and Doppler test to identify the type of defect and how to treat it.
What is the main principle of a microvascular surgery?
Microvascular surgery is based on the principle of reconstruction of surgical defects by the use of blood vessels, skin, fat, muscle, tissue and bone from other parts of the body. It is one of the most advanced surgical techniques for the treatment of surgical defects, mainly in the head, neck and arm region.
What does the procedure of microvascular surgery involve ?
Microsurgery basically uses the operating room microscope or high-powered loupe glass magnification to achieve the techniques of microvascular surgery to anastomose small vessels and nerves. Because of the possible long operative and fluid shifts associated with microsurgical cases, a complete blood count, type and screen or type and cross, coagulation panel to rule out coagulation disorders and basic chemistries are routinely ordered preoperatively. ECG and chest radiography are also a part of the routine preoperative workup. Additional laboratory studies and tests such as pulmonary function tests are necessary, depending on the general health and age of the patient. The microsurgical technique has to be performed meticulously. It is better to remain vigilant during postoperative care to ensure success of the procedure.
After the influence of anaesthesia is evident, the surgeon decides the site from where the graft material has to be obtained. Once the graft material is ready it is used to construct the defect in the tissue. The procedure also incorporates precise suturing of 2-3mm blood vessels with the help of a intra operative microscope/ surgical loupes, tiny, ultrafine needles. Incorporation of a blood vessels in the graft increase the post-operative outcome by reducing the healing time. Once the grafts and blood vessels are positioned in the required site, Doppler ultrasonography can be used to check to check the blood flow and the viability of the blood vessels. Post operatively the patient is shifted to the intensive care unit for close monitoring and once the patient’s condition is stable, he/she is shifted to the wards. The average stay of the patient in the hospital is about 7-10 days as the healing of the graft and the reconstructed site requires close monitoring and evaluation.
Once the blood vessels are sutured in place the formation of a platelet plug or a thrombus/ clot takes about 3-5 days and a new lining of the blood vessels is evident by the end of 1-2 weeks. Hence, initially after the reconstruction procedure is performed it is required to closely monitor the reconstructed defect site. The patient is advised to not lift any heavy weights or engage in sports or strenuous activities till advised fit by the consulting specialist.
Where are the grafts derived from?
The grafts are derived from the areas where they are not of much importance and are far away from the site of the surgery. Tissue grafts are most commonly derived from the arms, legs, abdomen, buttocks and back and it again depends upon the type of surgical defect closure and size of the wound and the patients overall condition. Ask your treating surgeon for the complete details about the type of graft will be suitable for your surgery.
How long does it take to perform a microvascular surgery procedure?
On an average microvascular surgical procedure takes about 5-8 hours or more as it is a highly meticulous procedure which requires surgical skills and precision to reconstruct the surgical defect.
Is microvascular surgery performed under anaesthesia?
Yes, the microvascular surgical procedure is performed under the influence of general anaesthesia and sedation.
Is age an indication for a microvascular surgery ?
No, age is not a factor in deciding whether a microvascular surgery is indicated or not.
What are the risks and complications associated with a microvascular surgery?
Microvascular surgery is a highly advanced and major surgical procedure which requires trained and skilled surgeons for obtaining a successful outcome of the procedure. The complications related to anaesthesia may include nausea, vomiting, headache, gastric upset and loss of balance.
Complications related to the procedure per say include necrosis or death of the tissue grafted, graft failure due to inadequate vessel anastomoses, clot or haematoma formation, infection at the site of reconstruction, infection at the site from where graft was obtained and unsuccessful healing of the wound.
It is advised to ask your treating surgeon about the associated complications and risks before deciding for the procedure.
Microvascular surgery is an advanced surgical technique which is used for the reconstruction of surgical defects with the help of inclusion of blood vessels while grafting. Microvascular surgery is a highly challenging procedure as the chances of graft failure and overall failure of the procedure are on the high. With the advent of newer and micro surgical techniques the anastomoses of smaller vessels about 0.3mm is also achievable nowadays. Ask your consulting specialist if you are suitable candidate for a microvascular surgical procedure.
How to find and reach vascular surgeons for microvascular surgery ?
Now you can find and reach vascular surgeons for microvascular surgery from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple vascular surgeons, get cost estimate for microvascular surgery from different hospitals, compare things and then choose a vascular surgeon for microvascular surgery.
Find, reach and choose a vascular surgeon for microvascular surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
