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Plastic and Reconstructive Surgery

Microsurgery


The Division of Plastic Surgery at SickKids has played an important role in the development of m=Microsurgery in children and continues to be a world leader in this field.  Microsurgery involves the use of the operating microscope for magnification (up to 20x), the use of fine, specially designed instruments to carry out various tasks, and the use of extremely fine suture material to repair tissues, usually nerves and vessels.  The suture material is a fraction of the diameter of a human hair.

Microsurgery can be used to connect nerves and blood vessels.  The small structures in children are much more reliably connected with the aid of increased magnification, special instruments and sutures, and special surgical techniques and expertise.  Nerve surgery has been the area of focus of Dr. Howard Clarke.  His work on the brachial plexus injuries of the newborn is world renowned and the Brachial Plexus Clinic at SickKids is one of the largest in North America.  Joining him in the field of micronerve surgery is Dr. Greg Borschel, who also has a very active experimental laboratory, exploring ways to improve nerve recovery.

The second major area of microsurgery involves work with vessels or microvascular surgery.  Dr. Ronald Zuker and Dr. Greg Borschel collaborate with the SickKids liver transplant team and often repair the very small hepatic artery in live donor liver transplants.  The repair of small vessels with microvascular surgery techniques has also made replantation of amputated parts possible.  We offer this service to children province-wide. Lastly, microvascular surgery allows us to transfer tissue from one part of the body to another, a procedure called free tissue transfer.  The tissue is placed in a new location and a new circulation established by connecting the small vein and artery that supplies the tissue.  This is a valuable tool for reconstructive surgery, making possible some of the major tumor resections that are necessary to preserve life or limb.

The tissue transferred ranges from an intact digit (such as a toe) to skin, muscle, bone or any combination.  It is revascularized in its new location and serves as an important cover and protector for vital parts.  In the case of bone, it provides structural integrity.  Transfer of muscle can also be made to function in its new location.  This is highlighted by a reconstructive technique developed and modified by Dr. Ronald Zuker, Dr. Ralph Manktelow and Dr. Greg Borschel, whereby a thin strip of muscle from the thigh is used to provide animation in the face for facial paralysis patients.

Microsurgery is a powerful tool that has revolutionized reconstructive surgery.  Our division has led this transformation in children and continues to explore new areas for advancement.