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40-459: Otolaryngologists were the first physicians to use microsurgical techniques. A Swedish otolaryngologist , Carl-Olof Siggesson Nylén (1892–1978), was the father of microsurgery. In 1921, in the University of Stockholm, he built the first surgical microscope, a modified monocular Brinell-Leitz microscope. At first he used it for operations in animals. In November of the same year he used it to operate on

80-450: A chance of survival in their new location. After the surgery is completed, the blood vessels that feed the tissue transplant are reconnected to new blood vessels in the neck. These blood vessels are typically no more than 1 to 3 millimeters in diameter, which means that these connections need to be made with a microscope, which is why the procedure is called "microvascular surgery". Reconstructive surgery Reconstructive surgery

120-410: A paramedian forehead flap , as well as tummy tuck ( abdominoplasty ). Recent literature in medline also has noted implementation of barbed suture in these procedures. Biomaterials are, in their simplest form, plastic implants used to correct or replace damaged body parts. Biomaterials were not used for reconstructive purposes until after World War II due to the new and improved technology and

160-442: A patient with chronic otitis who had a labyrinthine fistula. Nylen's microscope was soon replaced by a binocular microscope, developed in 1922 by his colleague Gunnar Holmgren (1875–1954). Gradually the operating microscope began to be used for ear operations. In the 1950s many otologists began to use it in the fenestration operation, usually to perfect the opening of the fenestra in the lateral semicircular canal. The revival of

200-703: A short time, many models of organ transplants in rat and mice have been established. Today, virtually every rat or mouse organ can be transplanted with relative high success rate. Microsurgery was also important to develop new techniques for transplantation, that would be later performed in humans. In addition, it allows reconstruction of small arteries in clinical organ transplantation (e.g. accessory arteries in cadaver liver transplantation, polar arteries in renal transplantation and in living liver donor transplantation). Microsurgery has been used to treat several pathologic conditions leading to infertility such as tubal obstructions, vas deferens obstructions, and varicocele , which

240-1049: A small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. Reconstructive surgeons use the concept of a reconstructive ladder to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion, and free flaps. Reconstructive surgery procedures include breast implant removal, reduction mammoplasty, breast reconstruction, surgical correction of birth anomalies, congenital nevi surgery, and liposuction for lipedema . Cosmetic surgery procedures include breast enhancement , reduction and lift, face lift , forehead lift , upper and lower eyelid surgery ( blepharoplasty ), laser skin resurfacing ( laser resurfacing ), chemical peel , nose reshaping ( rhinoplasty ), reconstruction liposuction , Nasal reconstruction using

280-543: A sub-speciality prior to becoming a consultant. The typical total length of education, training and post-secondary school is 12–14 years. Otolaryngology is among the more highly compensated surgical specialties in the United States. In 2022, the average annual income was $ 469,000. reconstruction (*Currently recognized by American Board of Medical Subspecialties ) Study of diseases of the outer ear, middle ear and mastoid, and inner ear, and surrounding structures (such as

320-426: Is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition. Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery . In regard to training, plastic surgery is a recognized medical specialty and a surgeon can be a "board-certified" plastic surgeon by

360-422: Is a surgical reconstructive procedure using microsurgery. A region of "donor" tissue is selected that can be isolated on a feeding artery and vein; this tissue is usually a composite of several tissue types (e.g., skin , muscle , fat , bone ). Common donor regions include the rectus abdominis muscle , latissimus dorsi muscle , fibula , radial forearm bone and skin, and lateral arm skin. The composite tissue

400-502: Is a federal statute that "improving functionality and restoring appearance" are covered as reconstructive and medically necessary. This definition is contrasted with cosmetic surgery performed to improve aesthetics or the appearance of a body part. A plastic surgeon can perform both reconstructive and cosmetic procedures. Some procedures, such as a panniculectomy (aka tummy tuck) can be considered as cosmetic by one insurance company and reconstructive by another. The surgeon may not be using

440-466: Is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear , nose , throat , base of the skull , head, and neck. These commonly include functional diseases that affect

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480-455: Is most commonly moved during this procedure is from the arms, legs, and back, and can come from the skin, bone, fat, and/or muscle. When doing this procedure, the decision on which is moved is determined on the reconstructive needs. Transfer of the tissue to the head and neck allows surgeons to rebuild the patient's jaw, optimize tongue function, and reconstruct the throat. When the pieces of tissue are moved, they require their own blood supply for

520-466: Is necessary after replantation both on physical and psychological levels also became important. So, when fingers are amputated, for instance, a replantation surgeon must seriously consider the contribution of the finger to the overall function of the hand. In this way, every attempt will be made to salvage an amputated thumb, since a great deal of hand function is dependent on the thumb, while an index finger or small finger might not be replanted, depending on

560-806: Is one of the most frequent cause of male infertility. Microsurgical drainages by placing microvascular bypasses between spermatic and inferior epigastric veins as proposed by Flati et al. have been successfully performed in treating male infertility due to varicocele. Microsurgical treatment has been shown to significantly improve fertility rate also in patients with recurrent varicocele who had previously undergone non-microsurgical treatments. Otolaryngologist Otorhinolaryngology ( / oʊ t oʊ ˌ r aɪ n oʊ ˌ l ær ɪ n ˈ ɡ ɒ l ə dʒ i / oh-toh- RY -noh- LARR -in- GOL -ə-jee , abbreviated ORL and also known as otolaryngology , otolaryngology   –   head and neck surgery ( ORL–H&N or OHNS ), or ear, nose, and throat ( ENT ) )

600-410: Is transferred (moved as a free flap of tissue) to the region on the patient requiring reconstruction (e.g., mandible after oral cancer resection, breast after cancer resection, traumatic tissue loss, congenital tissue absence). The vessels that supply the free flap are anastomosed with microsurgery to matching vessels ( artery and vein ) in the reconstructive site. The procedure was first done in

640-548: The American Board of Plastic Surgery . However, reconstructive surgery is not a specialty and there are no board-certified reconstructive surgeons. More accurately, reconstructive surgery should be contrasted with cosmetic surgery . Reconstructive surgery is performed to Separately, the patient must be healthy enough so that the benefits of the procedure outweigh the risks of complications or death. A procedure could be considered reconstructive but not medically necessary due to

680-487: The Medicare or reimbursement criteria when referring to a procedure as reconstructive or cosmetic. Plastic surgeons, maxillo-facial surgeons and otolaryngologists do reconstructive surgery on faces to correct congenital defects, after trauma and to reconstruct the head and neck after cancer. Another good example is repair of a cleft palate, or cheiloplasty, which surgically corrects abnormal development, restores function to

720-487: The United States and Canada, otorhinolaryngology is one of the most competitive specialties in medicine in which to obtain a residency position following medical school. In the United Kingdom, entrance to higher surgical training is competitive and involves a rigorous national selection process. The training programme consists of 6 years of higher surgical training after which trainees frequently undertake fellowships in

760-726: The United States, trainees complete at least five years of surgical residency training. This comprises three to six months of general surgical training and four and a half years in ORL-H&;N specialist surgery. In Canada and the United States, practitioners complete a five-year residency training after medical school. Following residency training, some otolaryngologist-head & neck surgeons complete an advanced sub-specialty fellowship, where training can be one to two years in duration. Fellowships include head and neck surgical oncology, facial plastic surgery, rhinology and sinus surgery, neuro-otology , pediatric otolaryngology, and laryngology. In

800-497: The bony skeleton and connecting tendons and nerves as required. Robert Malt and Charles Mckhann reported the first replantation of two human upper extremities by microvascular means in 1964, with the first arm replanted in a child after a train injury in 1962 in Boston. Initially, when the techniques were developed to make replantation possible, success was defined in terms of a survival of the amputated part alone. However, as more experience

840-547: The case of multiple amputated fingers, a finger or fingers may be transposed to a more useful location to obtain a more functional result. This concept is called "spare parts" surgery. Microsurgical techniques have played a crucial role in the development of transplantation immunological research because it allowed the use of rodent models, which are more appropriate for transplantation research (there are more reagents, monoclonal antibodies, knockout animals, and other immunological tools for mice and rats than other species). Before it

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880-422: The early 1970s and has become a popular "one-stage" (single operation) procedure for many surgical reconstructive applications. Replantation is the reattachment of a completely detached body part. Fingers and thumbs are the most common but the ear , scalp , nose , face , arm and penis have all been replanted. Generally replantation involves restoring blood flow through arteries and veins , restoring

920-499: The facial nerve and lateral skull base) Rhinology includes nasal dysfunction and sinus diseases. Facial plastic and reconstructive surgery is a one-year fellowship open to otorhinolaryngologists who wish to begin learning the aesthetic and reconstructive surgical principles of the head, face, and neck pioneered by the specialty of Plastic and Reconstructive Surgery. Sleep surgery encompasses any surgery that helps alleviate obstructive sleep apnea and can anatomically include any part of

960-477: The four-volume textbook entitled simply Microneurosurgery . Advances in the techniques and technology that popularized microsurgery began in the early 1960s to involve other medical areas. The first microvascular surgery, using a microscope to aid in the repair of blood vessels, was described by vascular surgeon, Julius H. Jacobson II of the University of Vermont in 1960. Using an operating microscope, he performed coupling of vessels as small as 1.4 mm and coined

1000-424: The individual needs of the patient and the ability of the patient to tolerate a long surgery and a long course of rehabilitation. However, if an amputated specimen is not able to be replanted to its original location entirely, this does not mean that the specimen is unreplantable. In fact, replantation surgeons have learned that only a piece or a portion may be necessary to obtain a functional result, or especially in

1040-422: The inner ear and the vocal cords. Otolaryngologists and maxillofacial surgeons use microsurgical techniques when reconstructing defects from resection of head and neck cancers. Cataract surgery, corneal transplants, and treatment of conditions like glaucoma are performed by ophthalmologists. Urologists and gynecologists frequently now reverse vasectomies and tubal ligations to restore fertility. Free tissue transfer

1080-479: The lips and mouth and produces a more normal appearance. This meets the definition of reconstructive surgery and is mandated by state laws in at least 31 states, but could be denied as cosmetic by individual insurance companies in the remaining states. Other branches of surgery ( e.g. , general surgery , gynecological surgery , pediatric surgery , plastic surgery , podiatric surgery ) also perform some reconstructive procedures. Reconstructive surgery represents

1120-879: The middle fossa approach and perfected the translabyrinthine approach and began to use these techniques to remove acoustic nerve tumors. The first neurosurgeon to make use of the surgical microscope was a Turkish emigrant, Gazi Yasargil . In 1953 he studied neurovascular surgery during work with Prof. Hugo Krayenbühl in Switzerland. His ideas interested Dr. Pete Donaghy, who invited Yasargil to his microvascular laboratory in Burlington, Vermont . After his return to Zürich in 1967 Yasargil concentrated on discovering clinical applications to their novel inventions. Publications on that topic: Micro-Vascular Surgery and Microsurgery Applied to Neurosurgery won him international recognition. His lifelong experiences with microsurgery were recapitulated in

1160-447: The problem, but also comprehends bioengineering . Cellular and tissue engineering is crucial to know for reconstructive procedures. An overview of the standardization and control of biomedical devices has recently been gathered by D. G. Singleton. Papers have covered in depth the U.S. Food and Drug Administration (FDA) Premarket Approval Process (J. L. Ely) and FDA regulations governing Class III devices. Two papers have described how

1200-484: The risk to the patient. In addition, Section 1862(a) (1) (A) of the Social Security Act directs the following: "No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Therefore, outside clinical interpretation and carrier guidelines, there

1240-725: The second toe to thumb was performed in February 1966 by Dr. Dong-yue Yang and Yu-dong Gu, in Shanghai, China. Great toe (big toe) to thumb was performed in April 1968 by Dr. John Cobbett, in England. In Australia work by Dr. Ian Taylor saw new techniques developed to reconstruct head and neck cancer defects with living bone from the hip or the fibula . A number of surgical specialties use microsurgical techniques. Otolaryngologists (ear, nose, throat and head and neck surgeons) perform microsurgery on structures of

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1280-819: The senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face, scalp, and neck. The term is a combination of Neo-Latin combining forms ( oto- + rhino- + laryngo- + -logy ) derived from four Ancient Greek words: οὖς ous ( gen. : ὠτός otos ), "ear", ῥίς rhis , "nose", λάρυγξ larynx , "larynx" and -λογία logia , "study" (cf. Greek ωτορινολαρυγγολόγος, "otorhinolaryngologist"). Otorhinolaryngologists are physicians ( MD , DO , MBBS , MBChB , etc.) who complete both medical school and an average of five–seven years of post-graduate surgical training in ORL-H&N. In

1320-409: The stapes mobilization operation by Rosen, in 1953, made the use of the microscope mandatory, although it was not used by the originators of the technique, Kessel (1878), Boucheron (1888) and Miot (1890). Mastoidectomies began to be performed with the surgical microscope and so were the tympanoplasty techniques that became known in the early 1950s. The stapes mobilization operation had varying results and

1360-535: The term microsurgery . Hand surgeons at the University of Louisville , Drs. Harold Kleinert and Mort Kasdan, performed the first revascularization of a partial digital amputation in 1963. Nakayama, a Japanese cardiothoracic surgeon, reported the first true series of microsurgical free-tissue transfers using vascularized intestinal segments to the neck for esophageal reconstruction after cancer resections using 3–4 mm vessels. Contemporary reconstructive microsurgery

1400-469: The tremendous need for the correction of damaged body parts that could replace transplantation . The process involves scientific and medical research to ensure that the biomaterials are biocompatible and that they can assume the mechanical and functioning roles of the components they are replacing. A successful implantation can best be achieved by a team that understands not only the anatomical , physiological , biochemical , and pathological aspects of

1440-480: The upper airway. Microvascular reconstruction repair is a common operation that is done on patients who see an otorhinolaryngologist. It is a surgical procedure that involves moving a composite piece of tissue from the patient's body and to the head and/or neck. Microvascular head-and-neck reconstruction is used to treat head-and-neck cancers, including those of the larynx and pharynx, oral cavity, salivary glands, jaws, calvarium, sinuses, tongue and skin. The tissue that

1480-411: Was gained in this field, surgeons specializing in replantation began to understand that survival of the amputated piece was not enough to ensure success of the replant. In this way, functional demands of the amputated specimen became paramount in guiding which amputated pieces should and should not be replanted. Additional concerns about the patient's ability to tolerate the long rehabilitation process that

1520-561: Was introduced by an American plastic surgeon , Dr. Harry J. Buncke . In 1964, Buncke reported a rabbit ear replantation, famously using a garage as a lab/operating theatre and home-made instruments This was the first report of successfully using blood vessels 1 millimeter in size. In 1966, Buncke used microsurgery to transplant a primate's great toe to its hand. During the late sixties and early 1970s, plastic surgeons ushered in many new microsurgical innovations that were previously unimaginable. The first human microsurgical transplantation of

1560-426: Was introduced, transplant immunology was studied in rodents using the skin transplantation model, which is limited by the fact that it is not vascularized. Thus, microsurgery represents the link between surgery and transplant immunological research. The first microsurgical experiments (porto-caval anastomosis in the rat) were performed by Dr. Sun Lee (pioneer of microsurgery) at the University of Pittsburgh in 1958. After

1600-449: Was soon replaced by stapedectomy, first described by John Shea, Jr.; this was an operation that was always performed with the microscope. Today neurosurgeons are very proud to use microscopes in their procedures. But it was not always so: many prestigious centers did not accept that idea and it had to be developed in relative isolation. In the late 1950s William House began to explore new techniques for temporal bone surgery. He developed

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