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MICROSURGERY

What is microsurgery?

Reconstructive microsurgery is a surgical discipline in which specialized operating microscopes and precision instrumentation are used to repair intricate structures such as blood vessels and nerves less than a few millimeters in diameter. This field has made a major impact to restore form and function to individuals impaired by trauma, cancer, and congenital anomalies.

Microsurgery is a tool used by a few plastic surgeons to perform specific procedures including the transfer of tissue from one part of the body to another (free tissue transfer), reattachment of severed parts (replantation), and composite tissue transplantation.

Microsurgical procedures represent a wide range of highly individualized operations. Microsurgical reconstruction is typically reserved for complex reconstructive surgery problems when other options (primary closure, skin grafting, local or regional flap transfer) are inadequate. Common microsurgery procedures are:

  • Breast reconstruction using free tissue transfer

  • Head and neck reconstruction using free tissue transfer

  • Functioning free muscle transfer for certain types of muscle paralysis

  • Vascularized bone flap transfer

  • Complex wound reconstruction

  • Toe transplantation

  • Digit replantation

  • Nerve repair and grafting

  • Lymphatic reconstruction

"Surgeons who have the necessary training, expertise, and experience in reconstructive surgery are fit to perform cosmetic surgeries with excellent outcomes. Those surgeons only trained in aesthetic procedures will have much more difficulty doing the same. The more tools and training in plastic surgery the surgeons have, the more qualified they are! "

What should I expect during a consultation for microsurgery?

During your initial consultation, Dr Ricardo will evaluate you as a candidate for microsurgery and clarify what approach is best for you. Alternative and additional treatments may be considered, once he understands your medical condition. It is important to be completely honest during the consultation and be prepared to discuss your surgical goals, medical conditions, drug allergies, and medical treatments, current medications, vitamins, and herbal supplements; alcohol, tobacco, and drug use; and previous surgeries.

Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, take photographs, discuss the approach to your surgery, including the type of procedure or combination of procedures and tell you whether your expectations are in line with typical results, discuss any risks or potential complications.

The success and safety of your microsurgery surgery depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. It's natural to feel some anxiety; it's a bit of preoperative stress. Don't be shy about discussing these feelings with Dr Ricardo.

What are the risks of microsurgery?

Dr Ricardo will explain in detail the risks associated with microsurgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications. These risks and others will be fully discussed before your consent. It's important that you address all your questions directly with Dr Ricardo.

How should I prepare for microsurgery?

In preparing for microsurgery, you may be asked to get lab testing or a medical evaluation, take certain medications or adjust your current medications, stop smoking in advance of surgery and avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding.

The surgery will be performed in an accredited hospital and requires likely spending at least two days in the hospital for observation unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following the hospital’s discharge.

 

Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to make your surgical experience as easy, comfortable, and safe as possible.

What are the steps of a microsurgery procedure?

Step 1 – Anaesthesia
 
Medications are administered for your comfort during the surgical procedure. Microsurgical procedures are usually performed under general anaesthesia due to their precise nature and often extended duration.
 
Step 2 – Surgical procedure
 
A free tissue transfer using microsurgery involves a donor site and a recipient site. First, the recipient site may be prepared following, for example, surgical removal of cancer or scar tissue. Tiny blood vessels and nerves are carefully dissected at the recipient site. Once a suitable donor site is selected, tissue can be isolated on its unique blood supply. The tissue is then disconnected from the body, and blood vessels are reattached at the recipient site using an operating microscope.
 
Step 3 – Closing the incisions
 
Depending on your condition and specific procedure, you may have incisions that need to be closed with removable sutures, skin adhesives, or dissolving sutures.
 
Step 4 – See the results
 
The results of microsurgery will develop over time as swelling subsides. Your outcome may not be realized for several months.

What should I expect during my microsurgery recovery?

Following your microsurgery procedure, gauze dressings or bandages will be applied to your incisions. An elastic bandage or compression garment may minimize swelling and support the donor site as it heals following surgery. Small, thin tubes may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

Close monitoring of blood flow is always required following a microsurgical procedure, preferably in a hospital setting with dedicated staff that is familiar with caring for patients who have undergone microsurgery. Free flap monitoring depends on the operation and surgeon preference. The surgical incisions mustn't be subjected to excessive force, abrasion, or motion during the time of healing.

You will be given specific instructions on how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with Dr Ricardo. Remember to always follow his instructions to ensure the success of your surgery.

What results should I expect after my microsurgery?

The final results of your microsurgery procedure may be initially obscured by swelling and will develop over time. While advances in microsurgery can accomplish near miracles in reconstruction and replantation, your outcome cannot be fully predicted. For certain traumatic injuries, it may not be possible to achieve a completely normal function. In some situations, it may not be possible to achieve optimal results with a single surgical procedure, and another surgery may be necessary.

The practice of medicine and surgery is not an exact science, so results may vary based on the procedure in which microsurgery is used. Following Dr Ricardo's instructions is the key to the success of your surgery.

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