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Medicine: Microsurgery: Sew Small

Medicine: “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 re-attaching 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 her body. 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. And all the surgical activity revolves around
the most important instument, 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 jeweller’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 millimetres thick. The needle used for this can
be just 70 millimetres 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. But 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 you if you’d had your thumb smashed
beyond repair. But in the past 14 years, you would have been
in luck, if your feet were intact. Every year in North
America, hundreds of big toes are removed from feet and
grafted onto hands. Sometimes tendons are shifted from less
important neighbouring fingers to allow the thumb to work
better in its unique role of opposing the other fingers and
allowing us to grip.
While we in North America can live without our big toes and
never really miss them, people in Japan can’t. They need
their big toes to keep the common footwear, the clog, on
their feet. So their second toe is taken instead.
Farmers, labourers car accident victims and home handymen
are the people most often helped by microsurgery replants.
And because blood vessels are being reattached, burn victims
can now benefit. 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 to eat with instead of inserting
food though a feeding tube in 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 your body can be used as donor backups and recycled
into other damaged sites. And because your body won’t reject
your own tissue – a constant hazard in transplants – in this
case, you are your own best friend.
In everyday use, however, microsurgery is proving to be a
miracle worker, large and small. We take for granted, for
instance, all the complex nerve and muscle control that goes
into a simple a gesture as smiling. But one young woman
couldn’t. An accident left her with a face that was damaged
and unable to smile. Microsurgery reconnected severed nerves,
giving muscle control back to her face, restoring her looks
and giving her something to smile about.