====== Microvascular Surgery ====== **Microvascular surgery** is a highly specialized surgical technique used to connect small blood vessels (typically <3 mm in diameter) using a microscope and microsurgical tools. It is essential in revascularization, free tissue transfer, and neurovascular reconstruction. ===== 🔬 Core Principles ===== * Use of **operating microscope** (up to 40x magnification) * Delicate **microsurgical instruments** (fine forceps, micro-scissors, needle holders) * Use of ultrafine sutures (e.g., **8-0 to 11-0 nylon**) * **Intraoperative patency assessment**: * Micro-Doppler * Indocyanine green (ICG) angiography * Direct visualization ===== 🧠 Neurosurgical Applications ===== ^ Indication ^ Purpose ^ | **EC–IC bypass** | Augment cerebral perfusion (e.g., moyamoya, ICA occlusion) | | **Aneurysm trapping with bypass** | Bypass flow before vessel sacrifice | | **AVM resection** | Repair/reconstruction of feeding arteries | | **Skull base tumors** | Reconstruction of vessels post-resection | ===== 🩺 Other Surgical Applications ===== * **Plastic surgery**: Free flaps (fibula, radial forearm, ALT) * **Hand surgery**: Digital/limb replantation * **ENT and urology**: Microvascular decompression, penile revascularization ===== ✅ Critical Success Factors ===== * Minimize **ischemia time** * Precise **vessel size matching** * Intra- and post-op **antithrombotic management** (e.g., heparin, aspirin) * Continuous **flap monitoring**: * Doppler signal * Capillary refill * Skin temperature and turgor ===== 🎓 Training and Simulation ===== * **Microsurgical labs** with: * Chicken wing or rat femoral artery models * Synthetic vessel simulation * VR-based microanastomosis simulators ---- **Related topics**: * [[neurovascular:ec_ic_bypass|EC–IC Bypass]] * [[surgical_techniques:free_flaps|Free Flap Transfer]] * [[neurovascular:icg|ICG Angiography in Neurosurgery]]