Microsurgery

Sometimes big problems require microscopic solutions. Microsurgery, as it pertains to plastic and reconstructive surgeons, typically involves moving different parts of the body around and sewing small blood vessels (sometimes less than one millimeter wide) and nerves together under an operating room microscope at high magnification. Using these techniques opens up a long list of options for plastic surgeons to fix difficult problems.

One of the most common uses of microsurgery is in breast reconstruction, where skin and fat are carefully moved from the abdomen to the chest and the blood vessels from the abdomen are sewn to vessels in the chest wall to perfuse the moved fat. This same technique can be used all over the body to fix complex problems, such as motor-vehicle injuries, workplace injuries, and cancer reconstruction cases.

CANDIDATES

• The ideal microsurgery candidate with be a healthy patient without complex medical conditions.
• It is very important not to smoke (or vape) around the time of microsurgery. Smoking causes the carefully dissected vessels to constrict and carries toxins into the moved body part. This can cause the moved part (also called a “free flap”) to die.

Consultation

Regardless of the circumstances, Dr. McInnes will want to know your full medical history, medications, and smoking history. Dr. McInnes will perform a thorough physical examination, and plan out your surgical procedure. Imaging studies may also be required.

Procedure Details:

Reconstructive microsurgery is done under general anesthetic, usually at the Royal Columbian Hospital or Surrey Memorial Hospital. It isn’t uncommon to have two plastic surgeons available for more complex cases, as they are often lengthy and require two skilled surgeons.

After you’re asleep, one surgeon will typically dissect out blood vessels near the defect while the other surgeon carefully dissects out the tissue (aka “flap”) that needs to be moved. After both of these procedures are done, the tissue is moved to the defect area, and the “plumbing” is undertaken, which entails sewing the arteries and veins together under the microscope. Afterwards, the flap is assessed to make sure it’s getting enough blood and the plumbing is working well. The flap is then secured into it’s new position with sutures.

For additional information on microsurgical reconstruction, please visit: https://www.microsurgeon.org

Recovery

Following your surgery, you will be kept overnight in the hospital for at least one day, most commonly 3 days, but sometimes longer. You will usually be closely monitored by the nursing staff while in hospital. On your first night, the nurses will check on you every hour, just to make sure everything is going well with the flap.

Recovery depends on the specific case, and you will have contact with your surgeon throughout the process.

Risks

The specific risks of the operation depend on which procedure you’re having done. One the biggest concerns with microsurgery is if the vessels that were sewn together clot or twist, which could result in the moved tissue dying. While the risk of this happening is low, it is a real risk and can happen. Sometime you will need to go back to the operating to fix a plumbing issue, and once it’s been resolved the flap does fine.

Please download the consent form designed by the American Society of Plastic Surgeons (ASPS) for a detailed list and description of common risks involved with microsurgery. These will be discussed with you prior to your consent and it is important to address your questions with Dr. McInnes.