Surgery performed on very small structures like the blood vessels and the nerves utilizing specialized equipment is called microsurgery.
Microsurgical procedures are performed using techniques that have been used since the early part of the twentieth century.
Some of the techniques used include blood vessel repair and organ transplantation.
Numerous other surgical specialties also make use of the techniques used in microsurgery.
Case in point: otolaryngologists perform microsurgery when doing work on the inner ear or the delicate and small structures of the vocal cord.
Plastic surgeons also employ microsurgical techniques during reconstruction of damaged or disfigured tissues, muscles, or skin or when transplanting tissues from the patient’s body.
Equipment
Microscope
Operating microscopes used in microsurgery may vary depending on their use.
However, they have and share a few standard features.
Microscopes can be floor or ceiling mounted and comes with a movable arm.
The movable arm will ensure manipulation of the microscope’s position is possible and effortless.
Operating microscopes also come with a high intensity light source.
It also comes equipped with a set of lenses designed to make viewing the surgical site possible and convenient.
The rest of the surgical team will get a visual of the operating field through a video camera.
Typically, the magnification required for microsurgery is five to forty times (5–40x) magnification.
Higher magnifications however are required by surgeons when performing microsurgical repair.
Lower magnifications are ideal when identifying and exposing structures.
Instruments
Instruments that are used in microsurgery have been designed to make manipulation of delicate structures (read: barely visible to the naked eye) possible.
The instruments are also equipped with handles that are large enough so the users can hold them comfortably and securely.
Some of the instruments used in microsurgery include:
- Vessel dilators
- Scissors
- Forceps
- Vascular clamps
- Irrigators
- Needle holders
- Clamp applicators
Suture Materials
Suturing or stitching in microsurgery is done using specialized needles and threads.
The diameter or gauge of the suture threads will vary and will depend on the procedure performed.
It will also depend on the tissue that will be sutured.
Suture threads can be synthetic (made of polyester, nylon, wire, and other man-made materials) or natural (made of silk, linen, gut, and other materials).
It can also be absorbable (will break down after a specific period) or non-absorbable (will retain its strength for an indefinite period).
Needles used in suturing also comes in a variety of sizes, point types, and shapes.
Akin to the suture thread, the needle type used in microsurgery will also depend on the tissue that needs suturing as well as the procedure performed.
In essence, numerous reconstructive procedures that are difficult to carry out when done conventionally are made possible through microsurgery.
Some of the most common microsurgical procedures performed are:
Free-tissue transfers
Also known as free flaps, free-tissue transfers are often the option when reconstructing tissues that have been damaged and cannot be treated through skin grafts.
Removed tissues due to treatment or cancer or tissues that have been constricted after a burn can benefit from free-tissue transfers.
Tissues that can be transferred through microsurgical techniques include skin, bone, muscle, intestine, and fat.
Replantation
Replantation is considered an emergency surgery and is carried out to reattach an amputated body part (i.e. finger, arm, or foot).
Replantation is a procedure that adheres to a series of time and energy intensive steps during the reattachment of the structures.
For instance, when a bone is cut, it must be shortened slightly so that the blood vessels and the nerves can be reattached without any tension.
Transplantation
In some cases, a body part that has been amputated can no longer be reattached, or the tissue has become deformed secondary to injury or congenital defect.
In similar scenarios, transplantation is often the recommended option.
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