Questions about microsurgery

[Perzt]

I'm having a hard time grasping microsurgery. If we go by the definition it says that microsurgery is surgery that requires a operating microscope.

I can understand nerve surgery. But vascular anastomosis? It feels that if you are moving a flap, making anastomoses on arteries with a diameter of <1mm does not make that much difference. When watching some videos on it, rat fem artery (seems to be like 0,7mm-1,4mm), it seems like the setup takes sometimes to get in order. Then you could watch a CABG surgery with LIMA (2mm +- 1mm) where the surgeons sometimes have their arms in the air and sewing nicely.

What if I move a big flap and then wants to anastomose an artery with a diameter of 0,5mm, which I guess would dramatically increase the operation time, would that be very critical for the flap function? I mean, I guess it will be angiogenesis in that area?

I have googled some on flap surgery, but what average magnification is used (vary among different surgeons I guess but in general)? What's the diamter of the structure you have to get functioning for the flap to work?

What kind of microsurgery should ALL plastic surgeon be able to perform? I mean, should anyone doing a PS residency be able to operate with 30X magnification?

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[caffeinemia]

To answer some of your questions:

Flaps require the perfusion provided by your pedicle because ischemic soft tissue necrosis (ie not brain, heart, and other organs with higher metabolic demands) occurs on the timeline of hours and angiogenesis occurs on the days to week to months timeline based on a number of factors, with tissue thickness being the most practical factor. This is the limiting principle for free tissue transfer without a vascular supply, which does happen. They are called grafts -- like skin skin grafts.

 

[Perzt]

Thanks for your answer.

From what I think, if you do a regular flap (anterlateral thigh flap or w/e) there is one major vessel for example the perforator. Is it then necessary to connect all those tiny tiny arteries as well? I mean, if you have an quite big artery, I guess that can make the flap tissue non-ischemic until new small arteries have developed.

Then again, CT surgeons sutures LIMA without microscope. Then some vascular surgeons use microscope to suture vessels 2-3 fold bigger than LIMA? So I just don't see the rationale always for using microscope, some papers also states "this procedure has been performed with microscope, we tried with loupes instead and got the same result".

It just feels weird to have a microscope with 10-40X magnification (must be irritating to see one's tremor that is inevitable at those magnifications I guess..), when you can do the same work with loupes 2-5X magnification?

 

[plastic]

Depending on where you train, you might be doing micro with loupes (usually around 5x) or with a microscope. To answer your question about an ALT, usually it is only necessary to anastomose the descending branch of lateral femoral circumflex artery (which is 1.5 - 2.5 mm) and its vein. In some cases additional anastomoses are necessary.

In short, you can generally do micro with either loupes or a microscope, up to you.

 

[caffeinemia]

My flap and my car be turbo/super.