Microsurgery is a special type of plastic reconstructive surgery that takes many years of study and practice to do with a high level of skill. Microsurgery enables us to repair and restore the effects of an injury caused by a trauma to the body, such as torn skin or scarring from an accident or a burn. Microsurgery actually helps us restore the function, or use, of damaged body parts such as arms, legs and fingers. Many of our patients are adults or children who’ve experienced vehicle or construction accidents, or were born with birth defects or deformities that require repair.
How is Microsurgery Performed?
The “micro” part refers to the special microscopes we use while operating to see extremely small parts of the body, including the smallest nerves and blood vessels. We use small, precision operating instruments so we can pick up a section of healthy nerves, blood vessels and muscle, fat, skin or bone from a patient’s body, often from their back or abdomen (stomach). The term we use for this healthy collection of body tissue is a “flap.” When we pick up and transfer the healthy flap to the wounded area for repair, this is called a “free tissue flap.”
How Does the Tissue Flap Help Heal the Wound?
Simply put, we surgically pick up an area of the patient’s healthy (called “donated”) tissue and bring it to the wounded (called “recipient”) area. The donated blood vessels then have to be carefully attached to recipient blood vessels to keep blood flowing to the transferred tissue, or flap. The transferred flap covers or fills in the wound, supplying blood that helps the wound heal and actually becoming part of the body again in its new location.
How Does Microsurgery Improve Function and Appearance?
Microsurgery technique is used as part of “orthoplastic surgery,” which unites the fields of orthopedic and plastic surgeries to get body parts working (function) and appearing (cosmetic) as normal as possible. We use orthoplastic surgery to repair the function and appearance of:
Open wounds from vehicle collisions such as motorcycles, cars, bicycles and skateboards
Severe fire or acid burns
Nerve injuries caused by gunshots, explosives or chemicals
Feet, hands and fingers partially or fully severed (cut off) by equipment such as snow blowers, lawnmowers, carpentry tools or knives
How is Orthoplastic Surgery Used to Repair an Injury?
As an example, a car accident that results in a large leg wound that removes skin, fat and muscle down to the bone cannot heal on its own with just stitches and bandages, or even with a skin graft. The patient’s leg is missing muscle and fat that supports body weight for standing, looks cosmetically disfigured, and is at risk for infection.
In cases like this, the New York Group for Plastic Surgery microsurgeons work with a team of orthopedic surgeons to restore function, as well as cosmetic appearance, of the leg. First we thoroughly clean out the wound to prevent infection. The orthopedic team repairs the fractured bone, which may require inserting “hardware” such as rods and plates for reinforcement. We then perform a free tissue transfer to move a healthy tissue flap to repair the wound.
A free tissue transfer provides more benefit than just covering the wound, including:
Restores a barrier to prevent infection. If the hardware or bone inside the leg remains exposed, bacteria can easily invade and cause a serious infection
Creates a new periosteum for the bone to promote healing. The periosteum is a membrane, or covering, over bones that contains blood vessels and nerves that give nourishment and sensation
What if a Severe Injury Leaves No Blood Vessels for a Flap?
There are times when an injury, particularly to the leg or foot, is so severe that there are no suitable blood vessels left in the injured area to attach the healthy flap; without enough blood flow, the flap cannot survive in its new location. Without the flap in place to protect and heal the injury, the limb may have to be amputated. The microsurgeons at the New York Group for Plastic Surgery are among the few nationwide who successfully perform a challenging new procedure, called a “Free Cross Leg Flap,” to repair such severe injuries.
Here’s an example of how we repaired a young woman’s right foot and ankle severely injured in a motorcycle accident using a Free Cross Leg Flap:
After the orthopedic team used hardware such as metal rods to reinforce the patient’s fractured bones in her injured right foot and ankle, we selected and lifted out a layer of skin and fat from her left thigh to create the new tissue flap. We connected the flap to her uninjured left ankle's blood supply — we did so because this ankle had healthy, non-damaged blood vessels that could keep the tissue flap alive. We then crossed her ankles and draped the flap from the good ankle over to also cover the injured ankle.
The patient’s ankles remained crossed and connected for three weeks. During this time, the flap gained a strong blood supply within the damaged ankle as well. This meant the flap could be disconnected from the good ankle and survive on its own - a process called “neovascularization.” The flap now effectively covered the injured foot’s bone and metal, and our patient is now walking and using her foot to a great extent.
How is Orthoplastic Surgery Used to Reattach or Replace a Limb?
We use orthoplastic surgery to replace limbs or body parts damaged or severed (cut off) due to an accident, or missing at birth. For instance, free tissue flap can be used to reattach a severed thumb (called “replantation”), or the thumb may even be replaced with the patient’s big toe (called “transplantation”).
Can Microsurgery be Used for Breast Reconstruction?
Yes, we frequently use microsurgery to create new breasts when breast tissue is removed during a mastectomy to either treat or prevent breast cancer. We use microsurgery in these cases with either a DIEP breast reconstruction or as part of oncoplastic surgery to improve cosmetic outcome for a woman having lumpectomy to treat breast cancer.
How is Orthoplastic Surgery Used to Repair Nerve Damage?
Nerve damage, which can be caused by injury or illness, can result in lack of feeling in certain muscles or bones. Without feeling, it’s difficult or impossible to use the affected limb. A hand without feeling can’t grasp an object and a foot without feeling can’t be used for walking. Orthoplastic surgery can give a new, living nerve supply that provides sensation to make the limb useful again.
Can Orthoplastic Surgery Repair Children’s Injuries?
Yes. Unfortunately, we often have cause to perform orthoplastic surgery on children; on the positive side, we can frequently repair and save their limbs. A common way that children get severe injuries requiring a team of orthopedic and plastic reconstructive surgeons involves accidents with moving vehicles such as:
Lawn mowers: Young children may run onto the lawn and directly into the path of a ride-on or walk-behind lawn mower, or are allowed to ride on mowers from which they fall and are run over by the mower blades. Children should be kept far from all lawn mowers!
ATVs (All Terrain Vehicles): Teenagers and younger children are riding powerful, heavy vehicles at high speeds, getting injured in rollovers or crashing into other children standing in the area
Cars: Children dart into the street and are struck by moving cars, experiencing a powerful immediate impact and often being thrown into the air and landing on hard surfaces