Microvascular surgery is a technique which allows plastic surgeons to join together very small blood vessels. It has revolutionized limb replantation, organ transplantation and skin grafting.
The replantation of amputated limbs is a relatively new phenomenon in humans. It was only in the mid-1960s and early 1970s that successful human replantations were being reported in China, Japan, Britain and the U.S. Now it is fairly common for patients who have had an accidental amputation of all or part of a limb to be considered for replantation. The success of the operation, however, depends on a number of factors.
For instance, the younger the patient the better the result; a crush-type injury makes replantation far less satisfactory than does a straight slicing-type injury; and a severed finger is not as important as a thumb, which represents about 50 per cent of hand function. In general, the best results are with fingers and thumbs, with 75 per cent of patients obtaining excellent results and returning to work and 60 per cent of hand replantation cases achieving reasonable function. In the case of an arm, however, cosmetic appearance is usually excellent, but hand sensation and muscle power are poor. Therefore, a patient cannot return to work if he or she needs two-handed coordination. Other amputated structures which may be replanted are the scalp, the lip, the nose, the ears, the legs and the penis.
Microvascular surgery has also been used for tissue transfer on organs such as testes, bowels, joints and nerves, as well as for skin grafting. For instance, a part of the bowel can be used to replace part of the gullet.