Adult
Traumatic injuries, microsurgery and replantation
Reconstruction under the microscope
What it is
Microsurgery is the reconstruction of severe injuries using an operating microscope, which makes it possible to repair vessels and nerves one to two millimetres across with sutures finer than a hair.
It covers replantation of amputated fingers or hands, revascularisation, nerve repair and grafting, and free tissue transfer — moving skin, muscle or bone with its own blood supply from elsewhere in the body to cover a defect.
Symptoms
These are injuries rather than conditions: amputation, degloving, crush, high-pressure injection, complex open fracture, or a wound that cannot close because bone, tendon or hardware is exposed.
A word about high-pressure injection: a tiny entry wound on a finger, after contact with a paint or grease gun, looks trivial but is a genuine surgical emergency. It must be assessed without delay.
Non-operative treatment
There is no non-operative alternative to the acute injury itself. On the other hand, not everything amputated should be replanted, and that judgement is part of the treatment.
A single fingertip that is crushed or contaminated, or a level of injury where the result would be a stiff, insensate finger, does worse than a clean revision of the stump. A stiff, painful finger gets in the way of the whole hand; sometimes it is better to be shorter and more functional.
Surgical treatment
Time matters. Here is the correct way to transport an amputated part: wrap it in moist gauze, seal it in a bag, and place the bag on ice. Never in direct contact with ice, and never in water — both cause irreversible damage.
In the operating room the order is set: bone is stabilised first, then tendons, arteries, nerves and veins are repaired under the microscope. Free flaps are planned with imaging and take several hours.
Recovery expectations
Recovery is long and staged. The first days require close monitoring of the circulation of the replanted or transferred tissue, in a warm room, with no tobacco and no caffeine — nicotine in particular causes spasm of the repaired vessels and directly threatens the result.
Intensive therapy over several months follows. Sensation returns slowly as the nerves regrow — of the order of a millimetre a day. Later procedures to release a tendon or graft a nerve or bone are common: they are planned in advance and do not mean something has gone wrong.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.