Introduction

    The second part of magnified surgery is devoted to microsurgery. It is divided into three main chapters: basic microsurgical techniques, laboratory anastomosis techniques and basics of clinical microsurgery. Our goal was to provide general information and a text that can be easily accessible through Internet (http://web.szote.u-szeged.hu/expsur/hefop/angol/indexe.htm). This will allow us to continually update and improve the content.

Indications of microsurgery

    Microsurgery is a technique, not a specialty. It is used by many surgical professions including neurosurgery, traumatology, ophthalmology, oto-rhino-laryngology, maxillo-facial surgery, plastic surgery, urology, transplantation surgery, pediatric surgery and gynecology. Microsurgical procedures are defined as surgical interventions performed under optical magnification (loupe, operating microscope) with special operative devices. Microsurgery, however, does not only mean the use of special instruments, it also necessitates the possession and application of thorough topographic anatomical strategies.
    The major indication of microsurgery is approximation of vessels and nerves with 1. re-establishment of anatomical connections or 2. construction of new connection in the millimeter range or where sensitive structures are in the intimate surrounding (i.e. brain, etc.). It is important to note that the term "micro" is not completely synonymous with size, although most of the interventions are performed on structures which are at least one order of magnitude smaller than in macroscopic surgery and the proportions can be visualized only with optical magnification. "Micro"-surgery requires a higher level of cerebro-manual activity and acquisition of special skills. These aims can be achieved by a special attitude that is quite different from that of conventional surgery. Dynamism is inherent component of general surgery, but this should be replaced by a thoughtful and flawless trouble shooting. Accordingly, microsurgical procedures pose considerable challenge for the residents since reduction of mistakes and improvement of surgical competence can be achieved only by a substantial amount of practical learning.

Terminology

Microsurgery is defined as a surgical technique in which incisions, dissections, and sutures are performed with optical magnification usually with the aid of an operating microscope.
Neuro-vascular microsurgery is a field of microsurgery in which the anastomosis of peripheral nerves and vessels smaller than 2 mm diameter is realized with the intent of reinnervation or revascularization of limbs or tissues. Such techniques are applied in replantation procedures in reconstructive microsurgery.
Reconstructive microsurgery is a surgical field that uses the transfer of revascularized tissue in order to correct congenital or acquired defects.
Experimental microsurgery is used in three major areas:
1. research of biological phenomena,
2. design and improvement of new operating techniques or biomaterials,
3. teaching of vascular and neural microsurgical techniques. Experimental microsurgery is developing continuously because these techniques are initially tried and studied in a laboratory and applied in clinical practice later.