Microvascular surgery in orthopaedics and traumatology.

In the past ten years microsurgical techniques have been developed in the fields of neurosurgery, otolaryngology and plastic surgery. It is regrettable that most orthopaedic surgeons have shown little interest in such fine surgery. There are several situations where microsurgery would be of value in orthopaedic research and practice, especially the hand, nerves and small vessels. Research related to these fields has been reported by plastic surgeons such as Buncke and Schulz (1965, 1966), Buncke, Buncke and Schulz (1966), Smith (1966) and Cobbett (1967, 1969). In our department microvascular surgery has been practised since 1964. This basic research led to the successful reimplantation of a thumb by repair of the digital vessels (Komatsu and Tamai 1968) and experimental free muscle transplantation in dogs by microneurovascular anastomoses (Tamai, Komatsu, Sakamoto, Sano, Sasauchi, Hori, Tatsumi and Okuda 1970). The purpose of this paper is to review the history of microvascular surgery, to describe the instruments used, and to point out their usefulness in surgery ofthe musculoskeletal system. Modern trends in the experimental and clinical applications of these techniques will be presented, together with some of our experiences. History of microvascular surgery-The fundamentals of vascular surgery were established in 1902 by Carrel who first reported the “three stay suture technique” using silk for anastomosing the vessels. In 1908 both Carrel and Guthrie performed extensive experiments on organ transplantation using the technique of suture which appeared in Guthrie’s monograph Blood Vessel Surgery and its Applications, published in 1912. During the next thirty ‘ears there were few developments in this field, but numerous methods of anastomosis were reported between 1948 and 1960. Various machines to facilitate the anastomosis of blood vessels designed in Canada, America, Russia and Japan generated great interest in vascular surgery. Even so, the results in vessels less than 3 millimetres in diameter were mostly unsatisfactory. Jacobson and Suarez introduced microvascular surgery by demonstrating the value of the operating microscope in 1960. They also designed several special instruments and fine suture materials for this new technique. Further improvements in the instrumentation and suture materials were developed by Salmon and Assimacopoulos (1964) and by Buncke and Schulz (1965, 1966). The successful anastomosis of vessels with a diameter of only one millimetre became possible. Surgeons now had the tools for digital reimplantation or transplantation.