MICROSURGERICAL TECHNIQUES,一、Concept Microsurgery is a kind of surgical techniquues, operating on tiny structures under the microscope with sutures that are barely visible. It is a important advancement in the modern surgery.,History1921, Carl-Olof Nylen and Holmgen in Sweden first used the operating microscope for treatment of otosclersis. They are the founders of microsurgery.Lab stage: in 1960, Jacobson and SuarezClinical stage: From 70s, microsurgery was rapidly developed, it have been used in all branches of surgery. Broad applications have involved:example: replantation surgery; micro vascular free transfer of flaps, omentum, toes, bones and muscles; microlymphatic surgery and so on.,二、Conditions of Microsurgery Suitable magnification Appropriately instrument and sutures Training to acquire hand-eye-coordination through the microscope,（一）surgical magnifying loupes and operating microscope 1.Loupes: single used be heads magnifying from 24times, even to 6 times working distance 2025cm working view 25cm It is commonly used for micro-dissection and obtaining a free flap, but the surgeon feels easily tired with using it.,2. Operating Microscope:,optical system Lighting Support Supplementary installation,Single -headed -binocular warm lighting on table cameradouble-headed-binocular cold lighting standing movie-cameradouble-headed-binocular hanged video +observation tube,Requisite: Magnifying 1040 times Working distance 20cm Enough brighter Record system,The microscope is used for the actual repair because of the higher magnification and brighter illumination available. Its main benefit is improved vision of small structures through optical magnification and brighter illumination.,(二) Instrument and micro suturesInstrument: To ensure a high success rate in microsurgery,specially designed instruments are necessary. These instruments are very fine, small and of good quality. The following are the key instruments that must be available to a micro-surgeon. (1) non-toothed or smooth forceps (2) micro-scissors (angled and straight) (3) spring loaded micro-needle holder (4) micro vascular clamp( angled and straight) (5) micro vascular clips (6) vessel dilating forceps (7) approximating clamp and so on,2. Micro-sutures: monofilament nylon 7-0, 8-0, 9-0, 11-0 9-0 d 1.0mm, 11-0 d 3mm3. Besides: bipolar coagulator background contrasting material,（三）Training The purpose of training is to require a new eye- hand instrument coordination under the microscope.,三、Clinical Applications of Microsurgical Techniques: (一) Replantation surgery (二) Microvascular surgery 1.One stage toe-to-hand transfer 2.microvascular free flap transfer 3.microvascular free bone transfer (三)Microneural surgery (四)Microlymphatic surgery (五)Microsurgical reconstruction of small tubes (六)Microsurgical reconstruction of small organs,四、Microvascular Repair:(一) Principle: 1.Position and exposure 2.Anastomosis technique: 1)repair of normal vessels A. gentle handling of tissue B. Adequate debridement 2) blood flow is normal 3) similar diameter of vessel 4) minimal vessel tension 5) Correct suture tension and spacing,(二) Methods of microvascular anastomosis 1. End to end anastomosis 1) two-point method 2) three-point method 2. End to side anastomosis 3. Others,（三）Postoperative monitoring and treating: Because of the all-or-none nature of replantation and free flap surgery, postoperative monitoring is important. 1. Room T: 2528 2.Vital signs: 3.Position 4. Good clinical observation 1)color 2)cutaneous T 3)capillary congestion reaction 4)Doppler,THANKS,