Barcelona Consensus on Supermicrosurgery

Abstract

The popularity of supermicrosurgery has increased dramatically over the past few years, but the lack of agreement regarding the name of the technique and its applications has caused misunderstandings among microsurgeons when trying to communicate and compare surgical procedures. We report the consensus reached on the name used to refer to supermicrosurgery techniques following the First European Conference on Supramicrosurgery held in Barcelona (Spain) on March 4–5, 2010. Present applications, advantages, and disadvantages of supermicrosurgery are discussed. It was agreed that supermicrosurgery was the most accurate name to reflect the essence of this extremely delicate technique. According to Koshima, supermicrosurgery is a technique of microneurovascular anastomosis for vessels of 0.3 to 0.8 mm and single nerve fascicles. The range of applications for this technique has increased rapidly and now includes lymphedema treatment, nerve reconstruction, replantation and reconstruction of amputated fingertips, microsurgical flap salvage, and new possibilities for free tissue transfer. Supermicrosurgery is a remarkably useful reconstructive tool that involves a great deal of skill and has a steep learning curve for the microsurgeon to master. Although it is currently performed by only a minority of microsurgeons, we consider it will be incorporated into conventional microsurgery in the near future.

Keywords

supermicrosurgery - lymphedema surgery - facial palsy reanimation - replantation - perforator flap

• References

• 1 Koshima I, Yamamoto T, Narushima M, Mihara M, Iida T. Perforator flaps and supermicrosurgery. Clin Plast Surg 2010; 37 (4) 683-689 , vii–iii
• 2 Satyanand T, Sachin K. Microsurgery: an important tool for reconstructive surgery. Int J Pharma Bio Sci 2010; 1 (3) 1-11
• 3 Koshima I. Microsurgery in the future: introduction to supra-microsurgery and perforator flaps. Presented at the First International Course on Perforator Flap and Arterialized Skin Flaps. Special invited lecture. Gent, Belgium, June 13, 1997
• 4 Tamai S. History of microsurgery. Plast Reconstr Surg 2009; 124 (6, Suppl): e282-e294
• 5 Jacobson JH, Suarez EL. Microsurgery in anastomosis of small vessels. Surg Forum 1960; 11: 243-245
• 6 Buncke Jr HJ, Buncke CM, Schulz WP. Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses. Br J Plast Surg 1966; 19 (4) 332-337
• 7 Devauchelle B, Badet L, Lengelé B , et al. First human face allograft: early report. Lancet 2006; 368 (9531) 203-209
• 8 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (2) 113-141
• 9 Asko-Seljavaara S. Free style free flaps. In: Programs and Abstracts of the Seventh Congress of the International Society of Reconstructive Microsurgery. New York: 1983
• 10 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (4) 910-916
• 11 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (6, Suppl): e419-e426
• 12 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (6) 645-648
• 13 Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg 1971; 24 (1) 15-19
• 14 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (1) 32-38
• 15 Allen RJ, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995; 95 (7) 1207-1212
• 16 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96 (7) 1608-1614
• 17 Qassemyar Q, Sinna R. De la microchirurgie à la “supermicrochirurgie”: étude expérimentale de faisabilité et perspectives. Ann Chir Plast Esthet 2011; 56 (6) 518-527
• 18 Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 2006; 243 (3) 313-315
• 19 O'Brien BM, Sykes P, Threlfall GN, Browning FS. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 1977; 60 (2) 197-211
• 20 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 2003; 19 (4) 209-215
• 21 Felmerer G, Sattler T, Lohrmann C, Tobbia D. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery 2012; 32 (3) 171-177
• 22 Koshima I, Okumoto K, Umeda N, Moriguchi T, Ishii R, Nakayama Y. Free vascularized deep peroneal nerve grafts. J Reconstr Microsurg 1996; 12 (3) 131-141
• 23 Iida T, Nakagawa M, Asano T, Fukushima C, Tachi K. Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects. J Reconstr Microsurg 2006; 22 (5) 343-348
• 24 Koshima I, Narushima M, Mihara M, Uchida G, Nakagawa M. Fascicular turnover flap for nerve gaps. J Plast Reconstr Aesthet Surg 2010; 63 (6) 1008-1014
• 25 Koshima I, Soeda S, Moriguchi T, Higaki H, Miyakawa S, Yamasaki M. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers. Plast Reconstr Surg 1992; 89 (4) 710-714
• 26 Koshima I, Inagawa K, Urushibara K, Okumoto K, Moriguchi T. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000; 105 (5) 1666-1674
• 27 Koshima I, Inagawa K, Okuyama N, Moriguchi T. Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis. Plast Reconstr Surg 1999; 103 (3) 964-969
• 28 Pribaz JJ, Falco N. Nasal reconstruction with auricular microvascular transplant. Ann Plast Surg 1993; 31 (4) 289-297
• 29 Tanaka Y, Tajima S, Tsujiguchi K, Fukae E, Ohmiya Y. Microvascular reconstruction of nose and ear defects using composite auricular free flaps. Ann Plast Surg 1993; 31 (4) 298-302
• 30 Koshima I, Urushibara K, Okuyama H, Moriguchi T. Ear helix flap for reconstruction of total loss of the upper eyelid. Br J Plast Surg 1999; 52 (4) 314-316
• 31 Koshima I, Fujitsu M, Sugiyama N. Supermicrosurgery and perforator-to-perforator free flaps. In: Blondeel P, Morris S, Hallock G, Neligan P, , eds. Perforator Flaps: Anatomy, Technique and Clinical Applications. St. Louis: Quality Medical; 2006: 977-987
• 32 Koshima I, Nanba Y, Takahashi Y, Tsukino A, Kishimoto K. Future of supramicrosurgery as it relates to breast reconstruction: free paraumbilical perforator adiposal flap. Semin Plast Surg 2002; 16 (1) 93-100
• 33 Koshima I. Short pedicle superficial inferior epigastric artery adiposal flap: new anatomical findings and the use of this flap for reconstruction of facial contour. Plast Reconstr Surg 2005; 116 (4) 1091-1097
• 34 Koshima I, Urushibara K, Inagawa K, Hamasaki T, Moriguchi T. Free medial plantar perforator flaps for the resurfacing of finger and foot defects. Plast Reconstr Surg 2001; 107 (7) 1753-1758
• 35 Koshima I, Tsutsui T, Takahashi Y, Nanba Y. Free gluteal artery perforator flap with a short, small perforator. Ann Plast Surg 2003; 51 (2) 200-204
• 36 Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg 2010; 64 (3) 291-293
• 37 Masia J, Kosutic D, Cervelli D, Clavero JA, Monill JM, Pons G. In search of the ideal method in perforator mapping: noncontrast magnetic resonance imaging. J Reconstr Microsurg 2010; 26 (1) 29-35
• 38 Masia J, Clavero JA, Larrañaga JR, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg 2006; 59 (6) 594-599
• 39 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (5) 1529-1544