Microsurgery includes reconstructive surgery techniques of anastomosis of small vessels (MicroVascular surgery) and coaptation of nerves (MicroNeural surgery). It uses a microscope or a high-magnification loupe to help in perfoming reconstructive surgery. Microsurgery is performed for solving difficult reconstructive surgery dilemnas and problems. It is performed when the primary options of reconstruction like primary closure; wound healing by secondary intention; skin graft; and local or regional flap transfer is not possible.

DIEP Flap for Breast Reconstruction
TRAM Flap for Breast Reconstruction













Microsurgery comes much later in the reconstructive ladder. It is usually not the first choice except in certain circumstances. However, it offers the reconstructive surgeon an important tool to achieve complex reconstructive surgery by allowing transfer of free tissue from distant sites. Transfer of free tissue may include several different types like isolated tissue transfer; composite tissue transfer; functioning free muscle transfer; vascularized bone graft; and toe transplantation. In breast reconstruction, breast tissues may be built from the abdominal skin- fat layer by microsurgery; with silicon implants covered by a large muscle; or may also be built gradually by micro-fat grafting technique following liposuction. Additionally it may also include some specific tissue transfer like nerve graft and vein graft. In some cases, like in large defects of the face resulting from removal of tumor, transferring free tissues may be the best option for closure of the resultant defect. In large complicated open tibia fractures, microsurgery now plays greater role in initial coverage, wound healing and early mobilization. Dr Marko Godina, a visionary plastic surgeon in Ljubljana, Slovenia, has played a tremendous role in popularizing this approach.

Microsurgical Coaptation of Nerve Ends
Microsurgical Anastomosis of Artery & Vein










Dr Srinjoy Saha follows the following principles while performing microsurgery:
  • Careful patient selection.
  • Developing a good preoperative plan as well as a back-up plan.
  • Use of a well-defined 'workhorse' flap.
  • Meticulous microsurgery technique during operation.
  • Vigilant postoperative care.
Commonly Performed Free Tissue Transfers:
(Chart @ Medscape/e-medicine: http://emedicine.medscape.com/article/1284724-overview)
Defect TypeTissue DefectCommon Flaps
Coverage of exposed structuresOpen tibial fractures in the distal third of the legLatissimus dorsi muscle free flap; gracilis muscle free flap
Dead spaceObliteration of Maxilla Defect after maxillectomy for cancerRectus abdominus muscle free flap
Tissue defectBreast ReconstructionTransverse rectus abdominus myocutaneous (TRAM) free flap; deep inferior epigastric perforator (DIEP) flap; superior gluteal artery perforator (SGAP) free flap
Bone and soft defect
Mandible Reconstruction
Fibula osteocutaneous free flap
Bone and soft defectInfraorbital and Maxillary DefectParascapular osteocutaneous free flap
Facial muscle denervationFacial Paralysis with muscular atrophyGracilis muscle free flap
Digital amputationThumb AmputationGreat toe composite free flap
Digestive tract defectEsophageal ReconstructionJejunum free flap; anterior lateral thigh (ALT) free flap