[Vascular microsurgery and progress of free flap surgery]

Area of Science:

• Vascular Surgery
• Microsurgery
• Surgical Innovation

Background:

• The first vascular microanastomosis was described in 1960, introducing microsurgical techniques and improved instrumentation.
• Subsequent advancements included vascular intubation, laser, biological glue, microvascular anastomotic systems, and non-transfixing microstaples.

Purpose of the Study:

• To review the evolution and efficacy of various microvascular anastomosis techniques.
• To assess the success rates and limitations of different methods compared to manual anastomosis.

Main Methods:

• Literature review of 9,503 cases analyzing different microvascular anastomosis techniques.
• Evaluation of failure rates and complications associated with various methods.
• Assessment of factors influencing success, such as post-operative heparin administration and recipient site condition.

Main Results:

• Despite numerous innovations, manual anastomosis has not been supplanted, retaining a 6.6% failure rate.
• Post-operative subcutaneous heparin administration decreased the rate of vascular thrombosis.
• Free vascularized transplants are crucial for reconstructing defects from tumor ablation or trauma, primarily in head, neck, and limb regions.
• Reconstruction of irradiated recipient sites is a significant predictor of failure.

Conclusions:

• Manual vascular microanastomosis remains the gold standard despite ongoing technical advancements.
• While innovations have aimed to improve outcomes, they have not consistently outperformed traditional methods.
• Effective microvascular surgery, though demanding, is vital for complex defect reconstruction, with careful patient selection and post-operative care being critical for success.