Since then, the technique has been used in reconstructions that were previously limited by vessels of small caliber.
in reconstructions involving vessel repair in the distal finger. First introduced 20 years ago, the technique was pioneered by Koshima et al. The surgical technique utilizes highly delicate microsurgical instruments (30- to 80-micron needle micro-sutures) to accomplish small anastomoses ( 6). Supermicrosurgery is defined as a technique of microneurovascular anastomosis for vessels and single nerve fascicles of 0.3 to 0.8 mm ( 4). These advanced procedures have been grouped under the field of supermicrosurgery ( 4, 5).
Most importantly, today’s reconstructive surgeons are able to execute procedures that were previously unachievable, such as anastomosis of vessels with a caliber less than a single millimeter. The outcomes and complication rates from microsurgery have improved over the past few decades, allowing today’s microsurgeons to focus more on minimizing donor-site morbidity and maximizing the function and aesthetics of the reconstruction ( 3). Microsurgical procedures have evolved from simple soft tissue reconstruction to more sophisticated applications of these techniques, including vascularized lymph node transfer (VLNT) and perforator-to-perforator anastomosis ( 1, 2). Recent advances in technology and refinement of surgical techniques have ushered forth a new age in the field of reconstructive microsurgery. With continued experimentation, standardization of supermicrosurgical training, and high quality studies focusing on the outcomes of these novel procedures, supermicrosurgery can become a routine and valuable component of every microsurgeon’s practice. While supermicrosurgery was originally developed for procedures involving salvage of the digit tip, the technique is now routinely used in a wide variety of microsurgical cases, including lymphovenous anastomoses, vascularized lymph node transfers and perforator-to-perforator anastomoses. Thus, supermicrosurgery has become increasingly popular in recent years, and its applications have greatly expanded since it was first introduced 20 years ago. The technique offers several distinct benefits to microsurgeons, including the ability to manipulate small vessels that were previously inaccessible, and to minimize donor-site morbidity by dissecting short pedicles in a suprafascial plane. Supermicrosurgery, a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 mm, has revolutionized the fields of lymphedema treatment and soft tissue reconstruction.
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