Microsurgery

Some vessels are no wider than a millimeter, and some nerves thinner still. Microsurgery joins them under magnification to save tissue, function and limbs.

Microsurgery uses an operating microscope, fine instruments and stitches thinner than a hair to join blood vessels, nerves and lymphatic channels of one to three millimeters or less. Magnification makes the difference. It makes possible free flap reconstruction after cancer or trauma, breast reconstruction with the patient's own tissue, reattachment of amputated fingers, nerve repair and surgery for lymphedema. In a systematic review of 2,273 fingertip replantations, 86 percent of reattached parts survived and 98 percent of patients returned to work (Sebastin and Chung, Plastic and Reconstructive Surgery, 2011). In 1,612 breast reconstructions with thigh tissue, the flap succeeded in 99.6 percent (Zhu and Liu, Aesthetic Plastic Surgery, 2025). This page explains what microsurgery treats, free flaps, breast reconstruction, replantation, nerve repair, lymphedema surgery, limb salvage, risks and flap monitoring, the hospital stay, and how patients from abroad arrange planned microsurgery at Biruni Hospital in Istanbul.

What microsurgery is

A typical free flap artery measures one to three millimeters. Lymphatic channels may measure less than one.

The precision of the join decides whether the tissue lives.

Small vessels, large consequences

A clot the size of a grain of rice can kill a flap.

Tissue moved on its vessels depends entirely on a single artery and one or two veins joined under the microscope, so a twist, a kink, pressure from a hematoma, low blood pressure or a clot in the first days can cut off the blood supply, and the flap then has only hours before it dies, and microsurgical teams therefore check flaps around the clock and keep an operating room ready to re-explore a threatened join. Smoking, cold, dehydration, tight dressings and even a lying position that presses on the pedicle all raise the risk in those first days, so nurses, anesthetists and surgeons share a written plan for warmth, fluids, blood pressure and positioning, and patients and families learn what each check means and why the night-time checks matter just as much as those during the day. Families ask why a nurse wakes the patient every hour. A clot found early can be removed and the flap saved, while one found the next morning may be too late.

Most flaps survive. Vigilance keeps it that way.

What it treats

Free flaps

Perforator flaps spare the donor muscle.

Breast reconstruction with your own tissue

Donor sites

Reconstructing both breasts with DIEP flaps carried a modestly higher risk of total flap loss than one breast, odds ratio 1.48, in a meta-analysis of 5,120 patients, yet remains a recommended option (Tekdogan and colleagues, 2024).

Replantation

Repairing a vein as well as the artery improved survival in both zones of fingertip amputation (Sebastin and Chung, 2011).

Timing

A cooled finger may still be reattached up to 12 hours after injury, sometimes longer, while a hand or arm with muscle needs surgery within six hours.

The first hours after an amputation

What happens before the hospital matters.

Rinse the amputated part gently with clean water or saline, wrap it in moist gauze, put it in a sealed plastic bag and place the bag on ice water, never directly on ice, which freezes and destroys tissue. Press on the wound to stop bleeding, raise the hand, and go to the nearest emergency department with a hand surgery service.

Speed saves fingers.

Nerve repair

The earlier a nerve is repaired, the better the result. Delayed referral costs function.

Patience with nerves

Nerves regrow slowly, a millimeter a day.

A nerve repaired at the elbow may need many months to reach the hand, and feeling and strength keep improving for two years or more with hand therapy.

Recovery takes time. Therapy fills it.

Risks

• Swelling and bruising at the operated area and the donor site.
• Long operations under general anesthesia, from three to ten hours or more.
• Scars at the donor site.

Microsurgery-specific complications

A meta-analysis of 1,196 microsurgical patients found that routine aspirin after surgery did not reduce clots or flap loss but raised hematoma rates (Azam and colleagues, Microsurgery, 2025). Blood thinning is tailored to each patient.

Lymphedema surgery

Lymphovenous anastomosis connects blocked lymphatic channels to tiny veins, letting trapped fluid drain into the circulation through incisions of a few centimeters.

Advanced lymphedema with fat and fibrous tissue may need lymph node transfer or liposuction in addition.

Before surgery

Limb salvage

Monitoring and the hospital stay

A sudden change in flap color, swelling or temperature needs a call to the team at once.

Recovery

For patients from abroad

Emergency replantation must happen near the injury within hours, so patients from abroad come to us for planned microsurgery and for secondary reconstruction after earlier treatment elsewhere.

Cost

The price depends on the operation, its length, the number of teams and the hospital stay.