Reconstructive Microsurgery
"We bring back, refashion and restore to wholeness the features that nature gave but chance destroyed, not that they may be an advantage to the living soul, not as a mean artifice but as an alleviation of illness, not as becomes charlatans but as becomes good physicians and followers of the great Hippocrates. For though the original beauty is indeed restored . . . the end for which the physician is working is that the features should fulfill their offices according to nature's decree."
                                                                                                                                         Gaspare Tagliacozzi

Reconstructive microsurgery offers truly state-of-the-art care for some of the most clinically vexing problems that, until recently, were virtually unsolvable.

Microsurgery involves magnifying the visual field of surgeons to enable them to see better, dissect better and perform micro-manipulation. This magnification helps them to perform very precise surgery that was not possible in the past. The greatest impact of microsurgery has been in our ability to suture small blood vessels and nerves, thus making it possible to transplant tissues from one part of the body to another. Microsurgical techniques greatly enhance the reconstructive surgeon's armamentarium for dealing with a multitude of complex reconstructive problems. By reestablishing blood flow into and out of muscle tissue, skin, bone, or even a portion of small intestine, the plastic surgeon so trained is able to transfer tissues to distant deficient sites.

Microsurgery first drew clinical attention in the late 1960s and early 1970s when it was used mainly as a tool to assist with the reattachment of severed fingers and limbs. The dissecting microscope provided a means of visualizing and repairing injured small blood vessels and nerves. Its use in general reconstructive surgery soon followed.

Plastic surgeons learned that they could sever the blood vessels supplying a chosen donor tissue, and transfer it to a "distant" site where it was needed to solve a reconstructive problem. This new modality rendered many previous multi-stage procedures obsolete, and in many instances provided reconstructive options where none before existed.

Although a relatively new form of surgery, reconstructive microsurgery is now widely accepted. Over the last three decades more than 100 donor "flaps" — pieces of tissue completely severed from their place of origin that are transplanted to a new site to reconstruct a tumor defect — have been described, and a success rate of over 95% has been achieved.Microsurgical reconstruction is providing new and dramatic treatment options for patients affected by cancer, trauma and paralysis. Expendable segments of tissue are harvested from the patient and transplanted to restore both form and function. Circulation is reestablished in the relocated tissue by performing microvascular connections. Blood vessels in the transferred tissues are united to those in the recipient area utilizing an operating microscope and sutures finer than a hair. These microsurgical procedures are often referred to as free flaps or free tissue transfers. Damaged nerves can also be repaired with microsurgical techniques to restore sensation and movementMicrosurgical techniques have been developed to provide reconstruction of the breast, mouth, jaw, neck, scalp, face and pelvis.Microsurgical techniques are also available to treat patients with traumatic limb injuries, facial paralysis and genital-urinary abnormalities. Performing these procedures on a daily basis with a specialized and dedicated  team has created the environment required to make these complex surgeries predictable and reliable.
Reconstructive Microsurgery offers patients the most sophisticated care available for: 
  • Soft tissue trauma of the arms/hands and legs / feet.
  • Reconstruction after limb-sparing tumor extirpation.
  • Malignancies involving the head and neck, including
    the cervical esophagus, mandible and floor of the mouth.
  • Severe burn scar contracture of the neck and shoulders
  • Traumatic or congenital absence of digits, especially the thumb.
  • Breast reconstruction.
  • Limb salvage in patients with peripheral vascular disease.
  • Replantation of acutely severed body parts.
  • Management of difficult wounds.
  • Vascular and vasospastic disorders of the hand, such as
    Raynaud's syndrome.
  • Nerve injuries in the arms/hands and legs / feet.
The advent of microsurgery has been one of the most important developments in modern surgery, and it has made possible rapid, major advances in the field of plastic and reconstructive surgery.

Head & Neck Cancer Reconstruction

Many advances have been made in the treatment cancers of head and neck region .The desire to improve outcomes by preservation of tissue and function led to these advances and resulted in more rapid recovery and decreased cosmetic deformities while maintaining equal cure rates to prior techniques. As a result, the aim of many head and neck surgeons has been directed at further decreasing morbidity and improving functional outcomes.

The use of free tissue transfer and microvascular techniques for the reconstruction of head and neck defects is a relatively recent practice. earlier majority of head and neck defects were closed with either local tissue or random skin flaps that were pedicled  and these were done in stages with increased morbidity.

Free flaps can provide a much wider range of skin characteristics, making for better match to  the defect. Furthermore, microvascular transfer makes much more efficient use of harvested tissue as nearly all is used directly in the reconstruction. Also, many of free flaps have the potential for functional neurosensory and motor innervation

Due to increased success rates for free-flap surgery and superior aesthetic and functional results, microvascular free-tissue transfer to the head and neck has become a better method of reconstruction.
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Elite Mission Hospital
Koorkenchery, Thrissur, Kerala, India.
Phone: 0487- 3011400
  Email :sushruthainstitute@gmail.com
Website: www.thrissurplasticsurgery.com
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