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Microsurgery is general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts.
History
Several surgeons lay claim to the first microsurgical procedure. The first microsurgical transplantation of the great toe (big toe) to thumb was performed in April 1968 by Mr. John Cobbett, in England.
In Australia work by Ian Taylor saw new techniques developed to reconstruct head and neck cancer defects with living bone from the hip or the fibula.
Free tissue transfer
Free tissue transfer is a surgical reconstructive procedure using microsurgery. A region of "donor" tissue is selected that can be isolated on a feeding artery and vein; this tissue is usually a composite of several tissue types (e.g., skin, muscle, fat, bone). Common donor regions include the rectus abdominis muscle, latissimus dorsi muscle, fibula, and radial forearm bone and skin lateral arm skin. The composite tissue is transferred (moved as a free flap of tissue) to the region on the patient requiring reconstruction (e.g., mandible after oral cancer resection, breast after cancer resection, traumatic tissue loss, congenital tissue absence). The vessels that supply the free flap are anastomosed with microsurgery to matching vessels (artery and vein) in the reconstructive site. The procedure was first done in the early 1970s and has become a popular "one-stage" (single operation) procedure for many surgical reconstructive applications.
Replantation
Replantation is the reattachment of a completely detached body part. Fingers and thumbs are the commonest but the ear, scalp, nose and penis have all been replanted. Generally replantation involves restoring blood flow through arteries and veins, restoring the bony skeleton and connecting tendons and nerves as required.
Transplantation
Techniques
"Microsurgery"