Microsurgery: Sew Small

A man came into the emergency ward at one o'clock. His
thumb came in an hour later. The surgeon's job: get them
back together. The successful reattaching of fingers to
hand requires long hours of painstaking work in
microsurgery. In the operating room , the surgeon doesn't
stand, but sits in a chair that supports his/her body.
His/her arm is cradled by a pillow. Scalpels are present as
are other standard surgical tools, but the suture threads
are almost invisible, the needle thinner than a human hair.
All the surgical activity revolves around the most
important instrument, the microscope. 

The surgeon will spend the next few hours looking through
the microscope at broken blood vessels and nerves and
sewing them back together again. The needles are so thin
that they have to be held with needlenosed jeweler's
forceps and will sew together nerves that are as wide as
the thickness of a penny. To make such a stitch, the
surgeon's hands will move no more than the width of the
folded side of a piece of paper seen end on! Imagine trying
to sew two pieces of spaghetti together and you'll have
some idea of what microsurgery involves. 

Twenty-five years ago, this man's thumb would have been
lost. But in the 1960s, surgeon's began using microscopes
to sew what previously had been almost invisible blood
vessels and nerves in limbs. Their sewing technique had
been developed on large blood vessels over a half century
earlier but could not be used in microsurgery until the
needles and sutures became small enough. The surgical
technique, still widely used today, had taken the
frustrating unreliability out of sewing slippery,
round-ended blood vessels by ingeniously turning them into
triangles. To do this, a cut end of a blood vessel was
stitched at three equidistant points and pulled slightly
apart to give an anchored, triangular shape. This now lent
itself to easier, more dependable stitching and paved the
way for microsurgery where as many as twenty stitches will
have to be made in a blood vessel three milliliters thick. 

The needle used for this can be just 70 milliliters wide,
only ten times the width of a human blood cell. All this
technology is focused on getting body parts back together
again successfully. The more blood vessels reattached, the
better the survival chances for a toe or a finger. The
finer the nerve resection, the better the feeling in a
damaged part of the face, or control in a previously
useless arm. 

The wounded and severed body part must be treated
carefully. If a small part of the body, such as a finger is
cut off, instead of torn, wrapped in a clean covering, put
on ice and then reattached within a few hours, the chance
of success is over ninety percent, as long as one good
artery and one good vein can be reattached. 

Not only is micro surgery allowing body parts to be
reattached, it's also allowing them to be reshuffled.
Before 1969, nothing could be done for a patient if a thumb
was smashed beyond repair. Today, in North America,
hundreds of big toes are removed from feet and grafted onto
hands. Sometimes tendons are shifted from less important
neighboring fingers to allow the thumb to work better in
its unique role of opposing the other fingers and allowing
us to grip. 

Farmers, laborers, car accident victims, and home handymen
are the people most often helped by microsurgery replants.
The ability to reattach blodd vessels also benefits burn
victims. Flaps of their healthy skin are laboriously
reattached more successfully, blood vessel by blood vessel,
to increase chances that the graft will take. Some women,
whose diseased Fallopian tubes have become blocked, can
have them reopened microsurgically. When a cancerous
esophagus must be removed, it can be replaced using a
section of the person's own bowel. These people can then
lead a more normal life, using their mouth for eating
instead of having food inserted through a feeding tube into
their stomach. Doctors have been able to rebuild an entire
lower face by sculpting the lower jaw from living hip bone
and covering it with the skin from that piece of bone. In
all, over seventy parts of the human body can be used as
donor backups and recycled into other damaged sites.