Microsurgery uses the operating room microscope or high-powered loupe magnification to aid in the techniques of microvascular surgery to anastomose small vessels and nerves. Microsurgical reconstruction is used for complex reconstructive surgery problems when other options such as primary closure, healing by secondary intention, skin grafting, or local or regional flap transfer, are not adequate.
Microsurgery may not be the best solution for all reconstructive dilemmas and usually is not the first choice in the reconstructive ladder. However, it can offer the reconstructive surgeon an important tool to achieve complex reconstruction by proceeding with free tissue transfer from distant sites. Free tissue transfer includes flaps such as isolated transfers, composite tissue transfers, functioning free muscle transfers, vascularized bone grafts, and toe transplantation (see the image below). In addition, specific tissue transfers such as neural grafts or vein grafts are also considered free tissue transfer. In specific cases, such as large defects of the face after tumor resection, free tissue transfer may be the best option for closure of the defect.