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Implementing Supermicrosurgery in Clinical Practice: Practical Applications from 100 Cases
Rajiv Parikh
*Plastic and Reconstructive Surgery, MedStar Plastic and Reconstructive Surgery; Georgetown University School of Medicine, Washington,
Background: Supermicrosurgery can expand the armamentarium of reconstructive surgeons by offering novel solutions to challenging problems. While supermicrosurgery has gained popularity internationally, in the United States, supermicrosurgery is performed by only a minority of reconstructive surgeons and taught in few microsurgery fellowships, with most experiences limited to lymphatic surgery. The purpose herein is to evaluate the feasibility of implementing supermicrosurgery in clinical practice and provide a guide to increase adoption of these techniques in the US.
Methods: This is a prospective study of consecutive cases performed by a single surgeon in their first 18 months of practice. Inclusion criteria required an anastomosis of 0.3 to 0.8mm in accord with the Barcelona consensus. Pre-clinical application occurred in the first three months and consisted of developing multi-specialty collaborations and technical skills. Patient factors, operative details, and complications were recorded.
Results: 100 patients underwent supermicrosurgery operations in 15 months, following the implementation period. Cases included: 63 lymphatic operations, 18 perforator to perforator flaps for limb salvage, 11 digital revascularization or replantation operations, 7 pure skin perforator flaps for upper extremity defects, and 1 extra-cranial to intra-cranial bypass. 20% of cases resulted from involvement in overnight call. Most cases (77%) were performed after the first six months, indicating a practice-building/learning curve.
Conclusions: Implementing supermicrosurgery is feasible for early-career reconstructive surgeons. Even without formalized training, surgeons can hone their skills prior to patient-care applications. Opportunities exist in lymphatic surgery, extremity reconstruction, neuroplastic surgery, and oncological reconstruction. Collaboration with other specialties and involvement in call can enable a broad-based microsurgical practice.
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