Microsurgical Reconstruction of the Extremities

Indications, Technique, and Postoperative Care

On April 23, 1906, Alexis Carrel presented his manuscript entitled "The Surgery of Blood Vessels" to the Johns Hopkins Medical Society. His work on the tech­ nique of small vessel anastomosis and the transplantation of visceral organs earned him the Nobel Prize in 1912. The use of magnification in operative surgery began in 1921 with the work of Nylen, who first employed the microscope for reconstructive procedures in the middle ear. Jacobson and Suarez published their initial observa­ tions on the use of microsurgery for the anastomosis of small vessels in 1960, and two years later, Malt reported the historic replantation of an upper extremity. To surgeons involved in reconstruction of the extremities, the evolution of micro­ surgery has provided the most significant advances of the past three decades. The dramatic clinical successes of replantation surgery and free tissue transfer have substantially improved functional and cosmetic results in addition to decreas­ ing morbidity in patients who present with complex reconstructive problems. Mi­ crosurgical Reconstruction of the Extremities crosses the traditional surgical discip­ lines and will be invaluable to orthopaedic surgeons, plastic surgeons, hand sur­ geons, and general surgeons, as well as to residents and fellows.