Microsurgical Neuro-Vascular Anastomoses

The thrust forward into small dimensions with the aid of high magni- fication (6-40 power) under the operating microscope marks an important development in almost all fields of surgery. Neurosurgery, ophthalmology and otorhinolaryngology have already integrated the binocular mono- scope as an indispensable tool into their armamentarium. General surgery is also making increasing use of it-as is the case with transplantations of autogenous free intestinal grafts. A great "victory march of microsurgery", however, appears to be taking place in plastic and reconstructive surgery. Reimplantation of arms, hands, and especially digits are hardly thinkable today without the possibility of high magnification. New microsurgical anastomosing techniques (interfascicular neurorrhaphy) have also improved the func- tional results after nerve injuries. Time-consuming reconstructive proce- dures, such as the transfer of a distant flap with its physical and psycho- logical burden, are being increasingly replaced by free flaps transplanted by microvascular suture techniques-the most popular free flap being the groin flap in which the superficial circumflex iliac artery and vein is reanastomosed to the recipient vessels. Nevertheless, the writer was sceptical when Dr. TSCHOPP set about with his ambitious plan to transplant a free autogenous rib graft in combination with its adjacent intercostal musculature. The evidence of the results obtained has given the lie to my scepticism. Dr. TSCHOPP has not only succeeded in securing the complete arterial and venous supply to the musculoskeletal graft at the recipient site but has also managed to preserve the functioning entity of nerve and muscle.