Reconstructive microsurgery is the subject of plastic surgery that deals with the treatment of complex deficits of anatomical structures, which arise due to oncological resections, injuries, burns, amputations or congenital anomalies, which leave a deficit in the skin or soft tissues, muscles, tendons , nerves and bones.

“It is a technique during the application of which structures, such as vessels and nerves with a diameter of a few millimeters, are restored with the use of a surgical microscope and precision tools,” explains Mr. Andreas Gravvanis, Director of the Plastic Reconstructive Microsurgery and Aesthetic Surgery Unit at the Metropolitan Hospital.

“Reconstructive Surgery”, he continues, “has evolved significantly in recent years, allowing the surgeon to manage lesions that require special handling and until recently could not be treated, while at the same time offering the patient a better quality of life and immediate solutions, as the specific operations no longer require multi-day hospitalization”.

How is Reconstructive Microsurgery applied to patients in need?

“The technique of reconstructive microsurgery is carried out by specialized plastic surgeons and concerns the transfer of tissues from one part of the body to another (free flaps), for the reattachment of amputated parts of the body (reattachment of an amputated finger) but also the transfer of complex parts of tissues. Procedures classified in this category are technically complex and are usually applied where other options such as direct suturing, skin grafts, and local or regional tissue transfer are insufficient to cover the deficit.

In planning the operation, the reconstructive surgeon will choose the tissue to transfer, choosing the donor area with the least morbidity for the patient. During the procedure, the tissue with its vessels is prepared, removed from the circulation, the surgeon shapes it based on the characteristics of the deficit, and then transfers it to the area of ​​need. In order for this tissue to survive, the surgeon must perform microvascular anastomoses under the microscope of the vessels of the area with the vessels of the tissue. Whereas, if he wants to give movement and sensibility to the area, he also restores the anatomical continuity of the nerves, turning the procedure into a complex microsurgical autotransplantation.

However, there are cases of patients whose own grafts have either been lost in the injury or are insufficient. Then, attempts are made to transplant allografts from donors (organ donors) with immunohistocompatibility. Thus, today appropriately selected patients receive face, hand and foot transplants. These cases are selected based on the necessity of the operation for the quality of life and that there is no alternative solution to allotransplantation, as these individuals will take life-long immunosuppressive drugs”, the expert points out.

In what cases are microsurgical techniques applied at Metropolitan Hospital?

“The Metropolitan Hospital team has experience performing more than 700 microsurgical autotransplants, in various parts of the body:

• Breast reconstruction: The most common operation is autologous breast reconstruction after radical mastectomy and radiation, where silicone implants cannot give a good and safe result. In this case, the first choice is the DIEP flap from the lower abdominal wall which essentially corresponds to the tissue removed in an abdominoplasty. A second option is the PAP flap from the inner surface of the thighs corresponding to the skin/fat removed in a cosmetic thigh lift.

• Facial paralysis: Where appropriate the Reconstructive Surgeon transfers either nerves or innervated muscles to provide movement to the patient’s face. When the facial nerve palsy is recent the appropriate method is neurotransmissions from branches of the contralateral healthy face and/or from the masseter nerve. Microneural sutures will be able to restore movement to paralyzed facial muscles. But when a long time has passed since the paralysis (more than 2 years), the muscles are permanently paralyzed and the solution is the microsurgical transfer of a functioning muscle. For example, the adductor laminar muscle can be transferred from the thigh to the face to correct the asymmetry of the smile, without causing a functional deficit in the leg.

• Head and neck oncological resections: In this case, the maxillofacial team of the hospital performs the oncological resection and then the Plastic Surgery team restores the tongue or jaw deficit, thus contributing to both oncological safety and appearance, function and the patient’s quality of life. For example, in case of removal of a large part of the jaw, the fibula bone whose cross-section resembles the cross-section of the jaw bone can be transferred and used to restore the deficit. Often there are cases of glossectomy due to cancer where the reconstruction is done with a flap from the thigh or arm that simulates the features of the tongue deficit.

Additional cases that can be treated are the transfer of a finger from the foot to the hand in case of amputation of the thumb, the reattachment/revascularization of the finger, the restoration of nerve deficits with nerve grafts, but also the restoration of lymphedema”, concludes Mr. Gravvanis.

*The Metropolitan Hospital has a model Plastic & Reconstructive Surgery Clinic, which operates based on the modern man’s need to improve his aesthetic image, as well as full information and the creation of the most specialized solution for every aesthetic imperfection. The clinic uses fast, painless and modern methods.

At the same time, in collaboration with the Oncology Clinic and the contribution of doctors of related specialties, the first Mole – Melanoma and Skin Tumors Clinic in Greece was created. Also, in collaboration with the Orthopedic Clinic and the Microsurgery & Extremity Clinic, the Plastic Surgery Clinic is on call and accepts emergency cases 24 hours a day.