Vessels rejoined under the microscope so transferred tissue survives and works.
Microvascular surgery joins blood vessels roughly one to three millimetres across under an operating microscope, using stitches finer than a human hair. It is what makes free tissue transfer, replantation and hand transplantation possible, and it underpins most complex reconstruction.
Before microsurgery, tissue could only be moved as far as its original blood supply reached. That limited reconstruction severely, and many injuries that are now repaired ended in amputation.
Joining vessels under a microscope changed that. Tissue can be taken from the thigh, forearm, back or abdomen, disconnected entirely, moved to where it is needed, and reconnected to vessels there. The unit in Surat has performed more than three thousand five hundred such transfers, largely for head and neck cancer reconstruction.
The vessels are between one and three millimetres across. Stitches are finer than human hair, and typically eight to twelve are placed around the circumference of each vessel. Both the artery and the veins must be joined, because tissue that receives blood but cannot drain it will still fail.
This is why operations run for many hours and why fatigue, magnification quality and team experience matter so much. It is also why these cases belong in units that do them regularly rather than occasionally.
The first seventy two hours after surgery decide whether the transferred tissue survives. It is checked hourly at first for colour, temperature and capillary refill. A flap that turns pale has an arterial problem, one that turns blue and congested has a venous problem, and each needs different action.
Detected early, a failing flap can often be rescued by returning to theatre and revising the join. Detected late, it cannot. That single fact is why patients stay in hospital with intensive monitoring rather than going home to rest.
| Factor | What it covers |
|---|---|
| Type of transfer | Different flaps involve different dissection and time |
| Duration of surgery | Commonly six to twelve hours for complex cases |
| Monitoring and stay | Intensive observation for the first seventy two hours |
| Return to theatre | Occasionally needed to revise a vessel join |
| Rehabilitation | Physiotherapy over the following months |
These pages answer the questions that most often come up alongside this one.
It varies with the type of transfer, the length of surgery and the intensity of monitoring afterwards. An estimate covering surgery, anaesthesia, hospital and intensive care stay is given once the operative plan is decided.
Complex free tissue transfer commonly runs six to twelve hours. The length comes from the precision required in joining vessels of one to three millimetres, not from any inefficiency.
Free flap survival is high in units that perform these regularly. However, an honest figure depends on the individual case, since smoking, diabetes, previous radiotherapy and the condition of the recipient vessels all affect it. Those factors are discussed openly beforehand.
Because a problem with the blood supply in the first days can often be corrected if found quickly, and cannot be if found late. Hourly checks in the first period are what make rescue possible.
Usually one to two weeks, including several days of close monitoring immediately after surgery.
Yes. The donor site, commonly the thigh, forearm or abdomen, is closed directly or with a skin graft, and leaves a permanent scar. This is explained clearly before consent, since it is a genuine trade.
Partial or complete flap failure, the need to return to theatre, bleeding, infection, donor site problems, and the general risks of prolonged anaesthesia including clots. Smoking raises the risk of flap failure considerably, which is why stopping before surgery matters.
Reconstruction after cancer, trauma or disease is frequently covered, and the hospital team assists with pre-authorisation. Cover is confirmed with the insurer before planned admission.
Published with written patient consent and shown for education rather than promotion. Every case is different and these images are not a promise of results.
Consultations at Kiran Hospital, Katargam, Surat. Outstation and NRI patients can request a video consultation before travelling.