Supermicrosurgery: Principles and applications

Hong, Joon Pio; Song, Sun Hong; Suh, Hyun Suk

doi:10.1002/jso.25243

Cited by 58 publications

(46 citation statements)

References 88 publications

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“…The microsurgery improvements allowed a safe management of increasingly small vessels leading to the introduction of perforator‐supplied free tissue transfers (Hong et al, 2018). The use of perforator vessels also in the recipient side is an attractive prospective that can solve much of the previously mentioned disadvantages.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, the improvement of supermicrosurgical technique and imaging resolution made possible to use perforators also as recipient vessels. This offers a series of advantages, allowing not only to spare the major deep vessels at the donor site but also in the recipient one (Hong et al, 2018). Over time this technique has been appreciated in many different body areas (Hong, 2009).…”

Section: Introductionmentioning

confidence: 99%

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Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review

et al. 2020

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Head and neck defect reconstruction is a common challenge for plastic surgeons. Microsurgical free tissue transfer is a frequently used solution but its success strictly depends on the quality of recipient vessels. A particularly demanding situation occurs when there are no nearby available vessels because of previous extensive neck dissection and radiotherapy. In similar cases, it is necessary to resort to other and farther vessels. Common alternatives might be the thoraco‐acromial vessels, the transverse cervical vessels, and the internal mammary vessel. Recently, the perforator vessels of the internal mammary artery and vein were shown to be safe alternatives as recipient vessels for autologous breast reconstruction, causing less morbidity and allowing adequate perfusion of rather large flaps. Here we present a floor of the mouth reconstruction after cancer relapse resection. In this case, we employed a chimeric anterolateral thigh (ALT) free flap anastomosed to the internal mammary perforator vessels in end‐to‐end fashion. A 46‐years‐old male patient presented a defect in the floor of the mouth and base of the tongue after cancer removal. No nearby vessels were available because of extensive fibrosis and damages due to previous surgeries and radiotherapy. Therefore, on the basis of our experience in autologous breast reconstruction, we chose the internal mammary perforator vessels in the recipient side and we harvested a chimeric ALT‐based skin island then split into two parts for mouth reconstruction and monitoring. We performed the anastomosis resorting to internal mammary perforator vessels and we obtained a satisfactory result from both the functional and aesthetic point of view. Postoperative course was uneventful and at 6 months follow up the reconstructive result was good with no functional issue. We believe that this might be a valid and modern evolution of the use of internal mammary vessels as recipient vessels and that it is a worthy addition in the field of perforator‐anastomosed flaps, extending its application also to head and neck reconstructions. Moreover, a brief literature review about alternative recipient vessels for depleted neck is also provided.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review

et al. 2020

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“…Supermicrosurgery is microsurgical anastomosis between vessels, with a diameter less than 0.8 mm. Using this technique, surgeons can choose any small random vessels such as perforating vessels near, or within the defects as recipient vessels (Hong et al, ). This concept expands the field of microsurgical reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…In the new concept of “supermicrosurgery,” surgeons use small random vessels (diameter lesser than 0.8 mm) near or in the wound as recipients. Using small perforators near the defect as recipient vessels does not require massive dissection of major vessels located deep under the skin and the blood flow across the anastomosis is more physiologic (Hong, Song, & Suh, ; Seo et al, ).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of radiation‐induced ulcers with free flaps using the perforating vessel as a recipient vessel

Kim

Kwon

et al. 2019

Microsurgery

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Background: Free flaps can be options for coverage of radiation ulcers. However, due to radiation damage, it may be hard to find and dissect a reliable recipient vessel for microsurgical anastomosis. When the radiation fields are targeted for deep tissues, superficial tissues may be less affected by radiation. Therefore, damage to perforator vessels near the skin may be lesser than that to the major vessels in deeper structures.We would like to introduce our experiences of using these less injured perforating vessels within or near the wound as recipient vessels for free flap coverage.Patients and Methods: From 2013 to 2015, 11 patients underwent free flap coverage for the treatment of radiation-induced ulceration. The location of ulcers were three cases of thigh, two cases of inguinal area, axilla, trochanteric area, chest wall, lower leg, perineal area, and back. Eleven cases were reconstructed using the anterolateral thigh (ALT) perforator flap, and in one case, the thoracodorsal artery perforator (TDAP) flap was used for inguinal area defect. With preoperative computed tomography, we found perforating vessels around the radiation ulcer.The perforating vessels that were identified before the operation were detected by hand-held Doppler during the operation and meticulous dissection was performed. In all-cases, the perforating vessels were accompanied by vena commitantes. A reliable perforator is one with visible pulsation, strong sound detected on Doppler, and sufficient diameter, preferably larger than 0.6 mm. Anastomosis was performed after confirming that the blood vessel was reliable.Results: The flap sizes ranged from 7 × 6 cm to 24 × 10 cm. No flap total necrosis developed. Patients were followed in the outpatient clinic for 21 to 31 months postoperatively. No patients experienced recurrence of ulceration during the follow-up. Conclusions:In free flap reconstruction of radiation ulcers, using perforating vessels within or outside the ulcer as recipient vessels provided less damaged vessels and healthier flaps for the defects with minimal wound complications. These perforating vessels can be a good option as recipient vessel for free flap coverage of radiation ulcers.

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“…Previous literature noted that the chicken thigh and wing models are much easier to obtain and use [16,18]. When using a chicken thigh as a model, intermediate and terminal secondary branches of vessels were measured to be from 0.3 to 0.8 mm, making them perfect targets for training specifically in lymphaticovenular anastomosis.…”

Section: Supermicrosurgerymentioning

confidence: 99%

Microsurgical education in the USA: Past, present and future

et al. 2021

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Microsurgery is a demanding surgical skillset which requires attention to detail and repeated practice to succeed. Microsurgery courses around the globe allow students to learn through performing a variety of technical exercises. Microsurgery education dates back to the late 1960s with notable instructors, Harry J. Buncke and Robert Acland. Currently, many microsurgery courses are available that share commonalities, and some important structural differences have been demonstrated to differentially affect student progression and competence. Multiple available training programs as well as the advancement of supermicrosurgery training is listed and described.The microsurgery training course at Columbia University’s New York Presbyterian Irving Medical Center led by Drs. Ronsenwasser, Strauch and Akelina provides students with expert instruction through a punctilious training curriculum. By imparting these techniques to the students, trainees’s progression markedly improves relative to alternative microsurgery courses that do not incorporate expert instruction. The Covid-19 pandemic, has resulted in the development of a virtual microsurgery training program at the lab which focuses on building the foundation of basic skills for trainees unable to travel or receive adequate education.

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Supermicrosurgery: Principles and applications

Cited by 58 publications

References 88 publications

Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review

Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review

Reconstruction of radiation‐induced ulcers with free flaps using the perforating vessel as a recipient vessel

Microsurgical education in the USA: Past, present and future

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