|Above: Microsurgical anastomosis between the Internal Mammary Artery and Vein to the Deep Inferior Epigastric Artery Perforator (DIEP) Vessels using an Operating Microscope. Dr. Alexis Carrell from the University of Chicago (1902) proved that we can successfully reconnect blood vessels using a technique called “triangulation”–he received the Nobel Prize for his efforts. Microscopes were used in vascular surgery in the 1960s (Jacobsen) and this allowed for blood vessels to be repaired that were less than 2millimeters. This began the revolution in Reconstructive MicroSurgery, the same techniques that allow us to Reconstruct the Breast by Tissue Transplantation (from the abdomen –TRAM, DIEP–, thighs, etc) and also allows Plastic Surgeons to transplant a hand or face.|
|Above: Close up of the Microsurgical Anastomosis (Reconnection between blood vessels)
Note the fine black sutures and precise interspacing to allow for free flow of blood between the 2 connectected blood vessels. These sutures are finer than human hair. The top, purple vessel is the Vein; the smaller, lighter pink vessel is the Artery. Reconnecting these blood vessels takes significant skill and patience.
The temperment of a Plastic Surgeon who performs Microsurgery is different from the average surgeon. Focused intensity, absolute precision (there is little margin of error for a microsurgical blood vessel connection to avoid a blood clot), creativity and the steadiest of hands are basic hallmarks. There is a reason why Reconstructive MicroPlastic Surgeons are a rare breed.