Microvascular Surgery

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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