Reconstructive Microsurgery

Microsurgery allows for reattachment of fingers, thumbs, or hand parts following accidental amputation. The procedure reconnects small blood vessels, nerves, tendons, and bones to restore both form and function.

These injuries damage multiple structures in the fingers, palm, and wrist, including blood vessels, nerves, and muscles. Microsurgical techniques repair these delicate structures and help prevent permanent hand disability.

When the nerves supplying the fingers and thumb are cut or damaged, microsurgery can repair these structures. This helps restore feeling and function that would otherwise be permanently lost.

Injuries to the small arteries and veins in the hand can lead to tissue death if not fixed promptly. Microsurgical repair of these vessels restores blood flow to affected fingers.

When earlier attempts to repair hand injuries have not produced satisfactory results, microsurgery offers another approach for reconstruction.

This technique takes tissue from one part of the body and moves it to the hand to replace damaged or missing tissue. The surgeon connects tiny blood vessels to establish blood supply to the transferred tissue. This method can provide skin, fat, tendons, or bone to repair complex hand injuries when local tissue is insufficient.

When a finger or thumb has been completely cut off, this technique reattaches the severed digit. The surgeon repairs bones, tendons, blood vessels, and nerves using a microscope. The success depends on the condition of the amputated finger, time since injury, and level of amputation.

For severed finger nerves, direct repair connects the nerve ends when possible. When there are gaps between nerve ends, nerve grafting uses segments from less important nerves (typically from the forearm or leg) to bridge the gap. This creates a pathway for nerve regeneration in the fingers.

This fundamental technique connects small finger blood vessels to restore circulation. The surgeon aligns the ends of severed vessels and places extremely fine sutures to create a secure connection. Restoring blood flow is necessary for finger or thumb survival after injury.

The procedure begins under general anaesthesia, though regional blocks may be used for less extensive repairs. The surgical site is thoroughly cleaned and draped. 

The surgeon makes incisions to expose the damaged area and assesses the condition of tendons, vessels, nerves, and bones. Any unexpected injuries not seen on imaging can also be identified during this stage.

A surgical microscope is positioned to allow for magnified visualisation. Damaged tissue is cleaned, and non-viable material is removed to prepare the site for reconstruction. For replantation cases, both the hand and the amputated part are carefully prepared.

If bone is involved, it is stabilised with pins, screws, or plates to restore alignment. Tendons and muscles are then repaired with techniques that maintain tension and minimise scarring, helping to support future movement.

Under magnification, blood vessels are reconnected with microsutures to restore circulation. Nerves are also repaired or grafted to promote sensory and motor recovery, with careful alignment to support regeneration.

Skin and soft tissues are closed using direct sutures, grafts, or tissue flaps, depending on the extent of the injury. Dressings are applied to protect the repair, monitor blood flow, and support healing.

While reconstructive microsurgery can effectively restore hand function, certain risks exist. These include infection at the surgical site and blood vessel problems such as clots or poor circulation that may require additional treatment. Nerve-related issues include incomplete sensation recovery in fingertips or failure of nerve regeneration. Repaired tendons may develop scarring that limits finger movement. Some patients may experience ongoing pain or cold sensitivity in the operated fingers. Other possible complications include reactions to anaesthesia and donor site problems.