Advances in Microsurgery

The beginnings of microsurgery date back to the early part of the century. In 1906, the first description of small vessel anastomosis was presented to the Johns Hopkins Medical Society by Alexis Carrel, who eventually won the Nobel Prize for his work in 1912. The next major advance, reported by Jacobson and Suarez in 1960, was the anastomosis of 1mm vessels. This feat was a pivotal accomplishment and soon became clinically feasible with the manufacture of fine needles (50μ to 100μ) and sutures measuring between 15μ and 20μ, or approximately three times the size of a human red blood cell. Two years later, Malt performed a landmark operation the first replantation of an upper extremity above the elbow and soon after, Susumi Tamai of Japan successfully reattached a completely amputated thumb. The first toe-to-thumb transplant was performed in the early 1970s, and, within a few years, free microvascular muscle and bone transplantation had been described. By the early 1980s, microsurgical procedures had undergone a dramatic evolution, seeing the development of an expansive array of microvascular alternatives to address a wide variety of clinical problems.