A severed finger or a deeply infected wound lacking enough skin can result from accidents and life’s challenges, causing severe bodily harm. Fortunately, surgical techniques have greatly advanced, allowing many of these issues to be resolved. One such technique, “microsurgery,” is a complex procedure that transfers a piece of tissue, including its tiny nerves and blood vessels, from one part of the body to another to reconstruct areas damaged by trauma or disease.

“Microsurgery requires specialized training and skills due to the precision needed to manipulate structures that are often only a few millimeters in size,” says Dr. Madhusudhan, a consultant hand, wrist, and microvascular surgeon at Bangalore Baptist Hospital. “For those who would have survived, microsurgery can dramatically improve their quality of life. It’s a powerful technique.”

Microsurgery has been around for decades, but it has now advanced to the point where it is used in various surgical fields. So, what exactly is microsurgery? Microsurgery utilizes instruments with very fine tips, high-magnification microscopes (up to 40 or 50 times magnification), and other tools to carefully disconnect tissue from one part of the body and reconnect it in another. These surgeries involve moving nerves and vessels that can be a millimeter or less in size. For comparison, a nickel is about 2 millimeters thick. These procedures can take hours, depending on the body parts involved and the surgery’s goal.

Only a limited number of surgeons are trained in this technique, primarily within the realm of plastic surgery. Many hand surgeons are also trained in microsurgery, enabling them to perform highly intricate procedures on tiny structures like nerves and blood vessels. This skill set is crucial for various hand surgery procedures, such as:

• Replantation of amputated fingers or hands
• Repair of complex fractures and ligament injuries
• Nerve repairs and grafts
• Tendon transfers and repairs
• Microsurgical reconstruction for severe trauma or deformities

Microsurgery for Reattaching Fingers and Thumbs

In hand surgery, microsurgical techniques are routinely used to reattach amputated fingers or thumbs, often due to traumatic accidents involving machinery or blast injuries from fireworks. Before the advent of microsurgery, amputation was often the only option. Today, surgeons can repair fingers, including arteries that are a fraction of a millimeter in diameter.

During the procedure, the missing structures are identified, and bones and tendons are pieced back together. Surgeons then perform microsurgery, connecting arteries, nerves, and veins to restore life to the severed digit. Reattaching a finger and restoring blood flow is delicate work, with digital arteries measuring about a millimeter in diameter and decreasing to fractions of a millimeter before branching into capillaries.

Microsurgery for Damaged Arms and Legs

Reconstructive limb surgery may be necessary if an arm or leg is seriously damaged in an accident, resulting in the loss of soft tissue covering the bone. Often, an infected wound also requires microsurgery. Without an experienced microsurgeon, such cases might necessitate amputation.

For instance, if a patient loses motor function in an arm, a muscle transfer can restore movement. Surgeons take muscle from another part of the body, such as the inner thigh, and connect it to blood vessels in the damaged area to create a new muscle that can move fingers or flex the elbow, depending on the surgery site. This process also involves connecting nerves so that an existing nerve in the arm can power the transferred muscle.

Care and support from specialized, certified physical and occupational hand therapists after surgery are also critical. These therapists play an enormous role in the recovery process.