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Microsurgical Techniques

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Book cover Plastic and Reconstructive Surgery

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

Summary

Although relatively young as a surgical discipline, microsurgery has become a critical part of the plastic and reconstructive surgeon's armamentarium over the last century. Familiarity with basic microsurgical instrumentation and technique, a sound understanding of indications for free tissue transfer, and judicious flap selection are paramount. Thoughtful operative planning and meticulous execution are essential to successful microsurgery. Careful postoperative flap monitoring as well as selective use of pharmacologic adjuncts, such as thrombolytics, heparin, aspirin, and dextran helps to ensure good outcomes. When flap viability is uncertain, reoperation and flap revision are required. Now routinely performed in most major medical centers, microsurgery has an exciting future due to the increasing demand and growing list of indications for these complex interventions.

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References

  1. Jacobson JH, Suarez EL. Microsurgery in anastomosis of small vessels. Surg Forum. 1960;11:243.

    Google Scholar 

  2. Nylen CO. The microscope in aural surgery, its first use and later development. Acta Otolaryngol Suppl. 1954; 116:226–240.

    Article  PubMed  CAS  Google Scholar 

  3. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg. 1972;49(3):268–274.

    Article  PubMed  CAS  Google Scholar 

  4. Thurston JB, Buncke HJ, Chater NL, Weinstein PR. A scanning electron microscopy study of micro-arterial damage and repair. Plast Reconstr Surg. 1976;57(2): 197–203.

    Article  PubMed  CAS  Google Scholar 

  5. Shenaq SM, Klebuc MJ, Vargo D. Free-tissue transfer with the aid of loupe magnification: experience with 251 procedures. Plast Reconstr Surg. 1995;95(2):261–269.

    Article  PubMed  CAS  Google Scholar 

  6. Ahn, CY, Shaw WW, Berns S, Markowitz BL. Clinical experience with the 3 M microvascular coupling anasto-motic device in 100 free-tissue transfers. Plast Reconstr Surg. 1994;93(7):1481–1484.

    Article  Google Scholar 

  7. Spector JA, Draper LB, Levine JP, Ahn CY. A technique for atraumatic microvascular arterial coupling. Plast Reconstr Surg. 2007;119(6):1968–1969.

    Article  PubMed  CAS  Google Scholar 

  8. Parry SW, Toth BA, Elliott L F. Microvascular free-tissue transfer in children. Plast Reconstr Surg. 1988;81(6): 838–840.

    Article  PubMed  CAS  Google Scholar 

  9. Shestak KC, Jones NF. Microsurgical free-tissue transfer in the elderly patient. Plast Reconstr Surg. 1991;88(2): 259–263.

    Article  PubMed  CAS  Google Scholar 

  10. Chang LD, Buncke G, Slezak S, Buncke HJ. Cigarette smoking, plastic surgery, and microsurgery. J Reconstr Microsurg. 1996;12(7):467–474.

    Article  PubMed  CAS  Google Scholar 

  11. Reus WF III, Colen, LB, Straker DJ. Tobacco smoking and complications in elective microsurgery. Plast Reconstr Surg. 1992;89(3):490–494.

    Article  PubMed  Google Scholar 

  12. Strauch B, Liang H-L Yu. Microvascular Surgery: Anatomy and Operative Techniques. 2nd ed. 2006, New York: Thieme Medical.

    Google Scholar 

  13. Giunta, RE, Geisweid A, Feller A.M. The value of preop-erative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg. 2000;105(7):2381–2386.

    Article  Google Scholar 

  14. Hamdi, M, Van Landuyt K, Van Hedent E, Duyck, P. Advances in autogenous breast reconstruction: the role of preoperative perforator mapping. Ann Plast Surg. 2007;58(1):18–26.

    Article  Google Scholar 

  15. Kroll SS, Schusterman MA, Reece G P, et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg. 1996;98(7):1230–1233.

    Article  PubMed  CAS  Google Scholar 

  16. Raittinen L, Laranne J, Baer G, Pukander J. How we do it: postoperative tissue oxygen monitoring in microvascular free flaps. Clin Otolaryngol. 2005;30(3):276–278.

    Article  PubMed  CAS  Google Scholar 

  17. Brown JS, Devine JC, Magennis P, et al. Factors that influ-ence the outcome of salvage in free tissue transfer. Br J Oral Maxillofac Surg. 2003;41(1):16–20.

    Article  PubMed  CAS  Google Scholar 

  18. Khouri RK, Sherman R, Buncke HJ, et al. A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery. Plast Reconstr Surg. 2001;107(2):408–415; discussion 416–418.

    Article  PubMed  CAS  Google Scholar 

  19. Conrad MH, Adams WP Jr. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg. 2001;108(7):2088–2096; quiz 2097.

    Article  PubMed  CAS  Google Scholar 

  20. Schubert W, Hunter DW, Guzman-Stein G, et al. Use of streptokinase for the salvage of a free flap: case report and review of the use of thrombolytic therapy. Microsurgery. 1987;8(3):117–121.

    Article  PubMed  CAS  Google Scholar 

  21. Hirigoyen MB, Zhang W, Gordon RE, Prabhat A, Urken ML, Weinberg H. Additional benefit of heparin in the thrombolytic salvage of ischemic skin flaps. Ann Plast Surg. 1995;35(6):612–619.

    Article  PubMed  CAS  Google Scholar 

  22. Weksler BB, Pett SB, Alonso D, et al. Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients. N Engl J Med. 1983;308(14): 800–805.

    Article  PubMed  CAS  Google Scholar 

  23. Clarke RJ, Mayo G, Price P, FitzGerald GA. Suppression of thromboxane A2 but not of systemic prostacyclin by controlled-release aspirin. N Engl J Med. 1991;325(16): 1137–1141.

    Article  PubMed  CAS  Google Scholar 

  24. Rosenberg RD. Actions and interactions of antithrombin and heparin. N Engl J Med. 1975;292(3):146–151.

    Article  PubMed  CAS  Google Scholar 

  25. Cox GW, Runnels S, Hsu HSH, Das SK. A comparison of heparinised saline irrigation solutions in a model of micro-vascular thrombosis. Br J Plast Surg. 1992;45(5):345–348.

    Article  PubMed  CAS  Google Scholar 

  26. Johnson PC, Barker JH. Thrombosis and antithrombotic therapy in microvascular surgery. Clin Plast Surg. 1992; 19(4):799–807.

    PubMed  CAS  Google Scholar 

  27. Das SK, Miller JH. Current status of topical antithrom-botic agents in microvascular surgery. Microsurgery. 1994;15(9):630–632.

    Article  PubMed  CAS  Google Scholar 

  28. Vlastou C, Earle AS. Intraoperative heparin in replantation surgery – an experimental study. Ann Plast Surg. 1983;10(2):112–114.

    Article  PubMed  CAS  Google Scholar 

  29. Cooley BC, Hansen FC. Microvascular repair following local crush and avulsion vascular injury. Microsurgery. 1985;6(1):46–48.

    Article  PubMed  CAS  Google Scholar 

  30. Engrav LH, Benjamin CI, Crandall H, Perry JF. Experimental effects of heparin or magnesium sulfate on the patency of microvascular anastomoses. Plast Reconstr Surg. 1975; 55(5):618–619.

    Article  PubMed  CAS  Google Scholar 

  31. Cooley BC, Lan M, Gould JS. Rat femoral vein-to-vein grafts as a microvascular practice model: factors that influence patency. Microsurgery. 1991;12(1):43–45.

    Article  PubMed  CAS  Google Scholar 

  32. Salemark L, Wieslander JB, Dougan P, Arnljots B. Studies of the antithrombotic effects of dextran 40 following microarterial trauma. Br J Plast Surg. 1991;44(1): 15–22.

    Article  PubMed  CAS  Google Scholar 

  33. Zhang B, Wieslander JB. Dextran's antithrombotic properties in small arteries are not altered by low-molecular-weight heparin or the fibrinolytic inhibitor tranexamic acid: an experimental study. Microsurgery. 1993;14(4):289–295.

    Article  PubMed  CAS  Google Scholar 

  34. Disa JJ, Polvora VP, Pusic AL, Singh B, Cordeiro PG. Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. Plast Reconstr Surg. 2003;112(6): 1534–1539.

    Article  PubMed  Google Scholar 

  35. Hein KD, Wechsler ME, Schwartzstein RM, Morris DJ. The adult respiratory distress syndrome after dextran infusion as an antithrombotic agent in free TRAM flap breast reconstruction. Plast Reconstr Surg. 1999;103(6): 1706–1708.

    PubMed  CAS  Google Scholar 

  36. Hardin CK, Kirk WC, Pederson WC. Osmotic complications of low-molecular-weight dextran therapy in free flap surgery. Microsurgery. 1992;13(1):36–38.

    Article  PubMed  CAS  Google Scholar 

  37. Kaplan AI, Sabin S. Dextran 40: another cause of drug-induced noncardiogenic pulmonary edema. Chest. 1975; 68(3):376–377.

    Article  PubMed  CAS  Google Scholar 

  38. Machado MA, Volpe P, Lima M das G, et al. [Anaphylaxis after dextran 40 infusion: report of a case and review of the literature]. Rev Hosp Clin Fac Med Sao Paulo. 1993;48(4):167–169.

    PubMed  CAS  Google Scholar 

  39. Ames A III, Wright RL, Kowada M, Thurston JM, Majno G. Cerebral ischemia. II. The no-reflow phenomenon. Am J Pathol. 1968;52(2):437–453.

    PubMed  Google Scholar 

  40. May JW Jr, Chait LA, O'Brien BM, Hurley J V. The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg. 1978;61(2):256–267.

    Article  PubMed  Google Scholar 

  41. Rinker BD, Stewart DH, Pu LL, Vasconez HC. Role of recombinant tissue plasminogen activator in free flap salvage. J Reconstr Microsurg. 2007;23(2):69–73.

    Article  PubMed  Google Scholar 

  42. Tran N V, Bishop AT, Convery PA, Yu AY. Venous congestive flap salvage with subcutaneous rtPA. Microsurgery. 2006;26(5):370–372.

    Article  PubMed  Google Scholar 

  43. D'Arpa S, Cordova A, Moschella F. Pharmacological thrombolysis: one more weapon for free-flap salvage. Microsurgery. 2005;25(6):477–480.

    Article  PubMed  Google Scholar 

  44. Puckett CL, Misholy H, Reinisch JF. The effects of strepto-kinase on ischemic flaps. J Hand Surg [Am]. 1983;8(1): 101–114.

    CAS  Google Scholar 

  45. Douglas B, Weinberg H, Song Y, Silverman DG. Beneficial effects of ibuprofen on experimental microvascular free flaps: pharmacologic alteration of the no-reflow phenomenon. Plast Reconstr Surg. 1987;79(3):366–374.

    Article  PubMed  CAS  Google Scholar 

  46. Mellow CG, Knight KR, Angel MF, O'Brien BM. The effect of thromboxane synthetase inhibition on tolerance of skin flaps to secondary ischemia caused by venous obstruction. Plast Reconstr Surg. 1990;86(2): 329–334.

    Article  PubMed  CAS  Google Scholar 

  47. Feng LJ, Berger BE, Lysz TW, Shaw WW. Vasoactive pros-taglandins in the impending no-reflow state: evidence for a primary disturbance in microvascular tone. Plast Reconstr Surg. 1988;81(5):755–767.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Risal S. Djohan & Steven L. Bernard

  2. Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Earl Gage

Authors
  1. Risal S. Djohan
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  2. Earl Gage
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  3. Steven L. Bernard
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Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Maria Z. Siemionow (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training) (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training)

  2. Department of Plastic and Aesthetic, Hand, and Reconstructive Surgery, Caritas-Krankenhaus St. Josef, affiliated with Regensburg University, Regensburg, Germany

    Marita Eisenmann-Klein (Director) (Director)

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© 2010 Springer-Verlag London Limited

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Djohan, R.S., Gage, E., Bernard, S.L. (2010). Microsurgical Techniques. In: Siemionow, M.Z., Eisenmann-Klein, M. (eds) Plastic and Reconstructive Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-513-0_8

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  • DOI: https://doi.org/10.1007/978-1-84882-513-0_8

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-512-3

  • Online ISBN: 978-1-84882-513-0

  • eBook Packages: MedicineMedicine (R0)

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