Procedures involved in General Microsurgery

Various procedures involved in microsurgery are:

AV fistula management
Local and regional flaps
Perforator flaps
Bone and soft tissue reconstruction following trauma

AV fistula management

An arteriovenous fistula (AVF) is not a normal connection between an artery and a vein. Sometimes, arteriovenous fistula is present at birth (congenital), or it may develop after birth, and sometimes they are the result of an injury (acquired).

Indication

The most common indication for the creation of an arteriovenous (AV) fistula is renal failure which requires chronic hemodialysis. It is performed to create a native fistula, although prosthetic material may be needed if a suitable vein is not available.

Some of the common forms of arteriovenous fistulas are:

Acquired arteriovenous fistulas are usually not present at birth. They happen when a sharp object goes through your body tissue, such as during a gunshot or stabbing injury.
Arteriovenous fistulas in the neck or face cause swelling and abnormal pulsing. They hardly cause any serious problems with brain development.
Dural arteriovenous fistulas happen within the dura, which covers the brain.
Peripheral arteriovenous fistulas take place outside of the head, neck, and spine.
Pial or cerebral arteriovenous fistulas happen in the brain.
Spinal arteriovenous fistulas occur in or next to the spinal cord.

AV fistula treatment

Arteriovenous fistulas can be treated with endovascular embolization, microsurgery, or stereotactic radiosurgery.

Endovascular embolization: The most common form of treatment for an arteriovenous fistula. EE procedure is performed by placing a catheter into an artery (usually the femoral artery in the front of the hip). Then, with the help of fluoroscopic or X-ray imaging, your surgeon will move it to the location of the fistula. Once the connection between the artery and the vein is closed, the AVF is cured and usually does not reoccur.
Microsurgery: Microsurgery is the most suitable treatment for a dural, brain, or spinal AVF, either alone or in combination with endovascular embolization. Dr. Nilesh Satbhai can tell you before the treatment if microsurgery will be necessary. With microsurgery, neurosurgery is also performed to visualize the AVF under a microscope and Dr. Nilesh Satbhai will place a titanium clip over the abnormal connection to prevent blood from flowing abnormally from the artery to the vein. During the procedure, Dr. Nilesh Satbhai can see the abnormal blood flow stop, and the abnormal vein changes from red (when it is carrying arterial blood) to blue, which is the normal color of veins. Immediately after the procedure, Dr. Nilesh Satbhai usually performs an angiogram to confirm that the AVF has been completely treated.

Benefits of AV fistula management

Following are a few of the most important benefits of this treatment:

Provides good blood flow for dialysis
Increases the effectiveness
Reduces treatment time

Risks of AV fistula management

As with any surgery, there are certain risks associated with AV fistula management. However, these risks are usually rare and can be effectively managed by Dr. Nilesh Satbhai . Some of the most common risks of AV fistula management include:

Infection
Bleeding
Blood clots

Local and regional flaps

Local flaps are those that are derived from the immediate area of resection, that is, local flaps are the use of tissue adjacent to the defect.

Common examples of these include:

Buccal pad of fat flap
Nasolabial flap
Facial artery musculomucosal (FAMM) flap

These types of flaps are advanced, transposed, or rotated into position and supplied by either an axial pattern or a random pattern.

Regional flaps are defined as those that are located near a defect but are not in immediate proximity. Regional flaps are frequently harvested from the neck, chest, or axilla.

Common examples of these include:

Pedicled latissimus dorsi flap
Pectoralis major flap
Deltopectoral flap

Goals of local and regional flaps

Adequate color match
Adequate thickness (to avoid protrusion or deficiencies)
Preservation of clinically perceivable sensory innervation
Sufficient laxity (to avoid deranged function or retraction)

Risks of local and regional flaps

Although all surgeries come with risks, those associated with local and regional flaps are relatively rare. Dr. Nilesh Satbhai is skilled in managing these risks so that patients can feel reassured about their surgery. Some of the most common potential complications include:

Infection
Persistent pain
Muscle weakness

Perforator flaps

Perforator flap surgery is a surgical technique used in reconstructive surgery where subcutaneous tissue or skin is removed from an adjacent or distant part of your body to reconstruct the part which is excised.

The vessels that supply blood to the flap are isolated perforators which are derived from a deep vascular system through your underlying muscle or intermuscular septa. Some of the perforators can have a mixed septal and intramuscular course before reaching the skin.

Septal perforator: A perforator that only traverses through the septum to supply the underlying skin is called a septal perforator.
Muscle perforator: A flap that is vascularised by a perforator traversing only through muscle to supply the underlying skin is called a muscle perforator.

Based on their vascular supply, these can be classified into direct and indirect perforators.

Direct perforators: Direct perforators pierce the deep fascia, they don’t traverse any other structural tissue.

Indirect perforators: Indirect perforators, before piercing the deep fascia, first run through the other structures.

Method of application

Free perforator flaps A free flap is defined as a mass of tissue that has been taken away from the original site to be used in tissue transplantation. When your surgeon uses a free flap, the blood supply is cut and the pedicle reattached to the recipient’s vessels, performing a microsurgical anastomosis.

Pedicled perforator flaps Pedicled perforator flaps are transferred either by translation (also called “advancement”) technique or rotation technique.

Advantages of perforator flap

Allows collection of tissue without scarifying the underlying muscles decreased postoperative pain
Accelerated rehabilitation

Indications of perforator flap

The need to cover exposed vital components such as vessels, tendons, joint surfaces, and bone free from the periosteum.
The need to reestablish function.
The need to restore structure and shape, like after a mastectomy.

Risks factors of perforator flap

Perforator flaps come with a small risk of complications. Dr. Nilesh Satbhai is an expert in mitigating these risks so that patients may rest easy during their surgery. The following are some of the potential risks of perforator flap:

Sepsis
Peripheral vascular disease
Possible respiratory problems

Bone and soft tissue reconstruction following trauma

The following procedures can be done for bone and soft tissue reconstruction after trauma.

Soft tissue reconstruction

The most commonly used tissue flaps for reconstruction are:

Fasciocutaneous flaps The anterolateral thigh (ALT) flap is the most popular flap for many reasons. The ALT provides extensive coverage, making it ideal for most defects.

Muscle flaps The latissimus dorsi (LD) flap, which is based on the largest muscle in the body, is used when a large amount of tissue and muscle is needed.

Bone stabilization

Bone fixation can be done by:

Plaster immobilization: When the bone is not displaced, it can be treated by plaster casting or splinting. The plaster cast is usually applied for 4 to 6 weeks till the bone heals.
External fixator: An external fixator is a metal frame that is attached to the bone with pins or screws. The frame holds the bone in place until it heals.
Internal fixation: Internal fixation is a surgery in which metal screws, plates, or rods are used to hold the bone in place internally.

Fractures in cases of remarkable or persistent bone contamination should be treated with external fixation until the bone has healed fully.