[Fifty years of plastic surgery in the Netherlands. VI. Microsurgery]

Use of the operating microscope created many new possibilities in plastic, reconstructive and hand surgery. Initially most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a technique suitable for more applications. Anatomical research of the blood supply of skin, fascia, muscle and bone identified flaps that could be carried by pedicle vessels. Transfer of these flaps and revascularization by microvascular anastomoses of the pedicle vessels set the stage for free flaps. In a few decades microsurgical techniques in plastic surgery fully matured. With free flap surgery single-stage and complex reconstructions could be achieved leading to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microvascular free tissue transfer is an essential part of plastic and reconstructive surgery. Further advances in microsurgery and free tissue transfers deserve to be mentioned: pre-fabrication of free flaps, reduction of donor site morbidity, development of artificial conduits and instrumentation and finally homologous transplantations.