1 Orchard Boulevard #10-08 Camden Medical Centre, Singapore 248649 | 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510
6 Napier Rd, #08-01 Gleneagles Medical Center, Singapore 258499 | Tel: +65 6737 4565 | Mobile: +65 8828 4565 | Email: clinic@polarisplasticsurgery.com

Reconstructive Microsurgery

What is reconstructive microsurgery?

Reconstructive microsurgery refers to the transfer of tissue from one part of your body to another part of the body utilizing microsurgical knowledge and techniques to maintain and restore blood supply to the transplanted tissue. This often requires the use of the operative microscope to perform surgery on blood vessels and nerves that are sub-millimeter in diameter. It is currently one of the most advanced methods for the restoration of defects in the face and body.

The cornerstone of reconstructive microsurgery is flap surgery. A flap is tissue with its own blood supply that is taken from one part of your body to replace missing tissue in another part. Almost any type of tissue can be taken as a flap, including skin, fat, muscle, bone, and nerve, either in isolation, or in combination as a chimera flap. When a flap is used without having to cut off its blood supply, it is referred to as a locoregional or pedicled flap. When the flap has its blood supply first cut off at the donor site and subsequently restored at the defect site, this is known as free tissue transfer or free flap surgery. With modern microsurgical techniques, free flap success rates remain consistent at 97 to 98%.

More recently, reconstructive microsurgery has given rise to the fields of perforator flap and supramicrosurgery. In the former, small perforating vessels to the skin are isolated and the tissue transferred to the defect site with minimal donor site morbidity. In the latter, vessels and lymphatics that measure 0.8mm or less in diameter are sutured together under a microscope to restore tissue viability and function, and is most noticeably used in surgery to treat lymphedema.

Am I a candidate?

Almost any defect from the head to the toes can be restored utilizing reconstructive microsurgery. Reasons for these defects include cancer resection, trauma, burns or congenital causes. It is most commonly performed for complex defects exposing vital structures such as vessels, bone and tendon, when robust coverage is required, such as in the head and neck region, or when function and aesthetics is restored using pedicled or free flaps.

How is it performed?

Your surgeon will conduct a thorough assessment of your medical and surgical issues as well as analyse the expected defect to be reconstructed. He will then discuss with you with the appropriate options for reconstruction, including the risks and benefits, and together you can make an informed choice.

Reconstructive surgery is commonly performed under regional or general anaesthesia, especially for larger defects. You will commonly be asked to fast for at least 6 to 8 hours before the procedure. Sips of water on the morning of the procedure are usually permitted.

During the procedure, the defect that requires reconstruction will be defined (recipient site). This is either from a pre-existing defect or created by resection which is usually done in the same sitting. As much as possible, your plastic surgeon will try to raise the flap to be used (donor site) for the reconstructive procedure concurrent with any resection that needs to be done to minimize anaesthesia time. Once ready, the flap will be brought into the recipient site and the donor site is closed. If a free flap procedure or nerve restoration is required, the operating microscope will be used to visualize these structures and delicately suture them together to restore continuity. Closure of the recipient site will then be completed. Quite often, drains will be placed to remove any excess blood or fluid, or monitor for post-operative bleeding or infection.
reconstructive microsurgery-2


Post-operative care, risks and complications

As reconstructive microsurgery procedures are highly complex, the patient will commonly need to be monitored closely for the first 24 hours after surgery. It is during this period where immediate post-operative issues such as bleeding and flap vascular problems can arise. If caught early, these problems can commonly be resolved with emergent surgery. Other issues such as pain will usually be well controlled with analgesics. Once the patient is stable after the first day, recovery generally progresses smoothly. Later post-operative issues include infection, scarring or the need for secondary surgery. Before the procedure, your plastic surgeon will often discuss the potential of these happening with you.

Why choose Polaris Plastic Surgery?

Our surgeons have trained extensively in reconstructive surgery and are board-certified microsurgeons who have published and presented widely on various topics in the field. They have, to date, performed hundreds of microsurgical reconstructions.

Schedule a consultation with one of our doctors to assess your needs and goals. They will communicate with you regarding your concerns, and in discussion formulate and perform the appropriate reconstructive procedure to optimize your functional and aesthetic outcomes.

1. Ooi A SH, Chang DW. Discussion: Volumetric planning using computed tomographic angiography improves clinical outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg 2016;137:781-782
2. Mirzabeigi MN, Wang T, Kovach SJ, Taylor JA, Serletti JM, Wu LC. Free Flap Take-Back following Postoperative Microvascular Compromise. Plastic and Reconstructive Surgery [Internet]. 2012 Sep;130(3):579–89.


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