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: