Microsurgical Procedures in Plastic Surgery

Microsurgery refers to the surgical coaptation of small structures (vessels, nerves, lymphatics, etc.), usually around 1 mm in diameter, performed under magnification with microinstruments and ultrafine sutures. This technique has evolved significantly over the last four decades, starting from revascularization and replantation to free-flap surgery. Advances in microsurgery led to consistently high success rates (96–98%) and made free tissue transfer a cost-effective, first-line option in reconstructive surgery with superior results and high patient satisfaction compared with conventional methods. However, it is mentally and physically demanding; therefore, ergonomics, a proper lifestyle, and special training cannot be overemphasized. Microsurgery is also a philosophy of thought because it opens the mind and allows us to reconsider the indications and surgical techniques already consolidated over time. It unleashes new possibilities to solve difficulties faced in the past in oncology, trauma, gynecology/urology, orthopedics, neurosurgery, otolaryngology, and ophthalmology. Microsurgery will not decline but will continue to evolve. With further refinements, we will see an even broader application, particularly, in the fields of supermicrosurgery, free-style free flaps, and composite tissue allotransplantation. Despite its no longer young age, microsurgery is an evolving technique still and, year after year, new ideas and solutions make its field of action ever more comprehensive and exciting. Moreover, new technologies such as smartphone apps, pre-surgical planning, and design-aided software are already a reality. The combination of robotic-assisted surgery and 5G may unleash the unlimited potential in microsurgery allowing world’s experts to perform procedures and train the young generation in any corner of the globe.