Incised or lacerated wounds on wrist or forearm may be associated with injuries of tendon, nerve or vessels (arteries and veins). These neuro-vascular injuries need to be repaired under magnification. Results of primary repair are always better.
Microsurgery has many implications-
Reimplantation surgery – Amputated body parts can be reimplanted back to life if surgery is done within time i.e. before it’s clinical death. Amputated part should be cleaned, wrapped in moist saline gauge and put in a dry polythene bag. This bag should be put in another bag containing ice. Ice should never come in direct contact of amputated part. Amputated part should neither be frozen nor water logged. Patient must be sent to a referral center as soon possible. Bleeding from major vessels should be controlled by local pressure. As far as possible, hemostat, ligature or proximal tourniquet should not be applied.
Re-implantation is usually not possible in cases of crush injuries. However it’s better to refer a non-candidate then to miss a deserving candidate.
Microvascular Tissue Transfer – Tissue transfer is the basic surgical tool for reconstructive surgery. Most of the times in cases of tissue loss, recostruction of lost tissue is done from local or regional tissue transfer. In case there is not sufficient donor site left in surrounding vicinity, reconstruction is done by distant tissue transfer. Either recipient site is joined at flap donor site for 3 weeks or desired transferable tissue is harvested from donor site along with its blood vessels and is transferred to recipient area along with these blodd vessels. This method is used for transfer of vascularised skin, muscle or bone flaps as required.
Peripheral nerve injuries – Nerves are like electric wires in body. Their function is to transfer signals from brain and spinal cord (central nervous system) to all other body tissues. These signals are either transferred from end organ to brain (like sense of touch, pain, pressure, taste, temperature, vision, smell) or from brain to end organs (eg. Signal from brain to muscles so as to carry out an action). In case of nerve injury there is loss of signal transmission between central nervous system and peripheral tissues and hence this leads to either loss of sensation or paralysis or both in affected area. In such situations repair of these peripheral nerves is done to restore this signal transmission. Restoration of result in these cases is very slow and not always, every function can be restored. Nerve repair is always done under magnification. Recovery of this nerve trnsmission path is very slow; at rate of approximately 1 mm per day with a delay of 3 weeks on both ends.
Vascular injuries – Vessels are of two types i.e. artery (those carrying blood from heart to other organs for supply of food and oxygen) and veins (those carrying blood from distant organs to heart to transfer waste of tissue metabolism etc.). In case of vascular injury there is loss of this transfer of oxygen and metabolites. In such case the affected part of body may die because of lck of oxygen or accumulation of metabolites. Vascular anastomosis needs to be performed under magnification in these situations to restore the blood supply. This is an emergency and surgery needs to be performed under stipulated time.
Recanalisation of fallopian tube or vas: Devision of fallopion tube (tubectomy) in females or vas (vasectomy) in males is permanent method to prevent pregnancy. In certain situations effect of this surgery needs reversal. This is done by microsurgical re-union of devided tubes (fallopion tube or vas-deference) under magnification.
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