====== 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

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**Related topics**:
  * [[neurovascular:ec_ic_bypass|EC–IC Bypass]]
  * [[surgical_techniques:free_flaps|Free Flap Transfer]]
  * [[neurovascular:icg|ICG Angiography in Neurosurgery]]