Reconstructive microsurgery

Reconstructive microsurgery employs high-precision techniques using an operating microscope to repair small-calibre structures: nerves, arteries, veins and tendons. It is essential in the management of severe trauma, post-traumatic sequelae and complex reconstructions of the hand and upper limb.

Main indications

• Digit replantation: reconnection of traumatically amputated fingers
• Nerve repair: direct suturing or nerve grafting to restore sensation and motor function
• Microsurgical flaps: transfer of tissue (skin, bone, muscle) from other body regions to reconstruct complex defects
• Reconstruction following tumour resection: coverage and functional restoration after excision of bone or soft-tissue tumours
• Infection sequelae: reconstruction of bone and soft-tissue defects secondary to severe infections
• Tendon transfers: restoration of lost functions by transferring functioning tendons

Techniques used

Microsurgery requires specialised instruments and an operating microscope with up to 40× magnification. The sutures used are finer than a human hair (9/0 to 11/0). Key techniques include: vascular anastomoses (joining arteries and veins of less than 1 mm in diameter), neurorrhaphy (nerve repair), nerve grafting and free vascularised flaps.

Digit replantation

Replantation involves reconnecting a finger or hand segment that has been traumatically amputated. It requires urgent intervention, ideally within the first six to eight hours, and involves reconnecting arteries, veins, nerves and tendons under the microscope. Outcomes depend on the level and type of amputation, the condition of the tissues and the speed of surgical intervention.

Recovery

Recovery following microsurgery varies according to the procedure performed. Replantations require hospital admission and close monitoring during the initial days. Rehabilitation is prolonged and intensive, yet it enables functional recovery in cases that would otherwise result in permanent loss. Nerve regeneration, for example, progresses at a rate of approximately 1 mm per day, meaning that final results are assessed at six to twelve months.