Microvascular Surgery Course

Lesson 1 • History and Evolution of Microsurgery

Traces milestones from early vessel repair to modern free-flap transfer. Contextualises current techniques within a century of technical innovation.

Lesson 2 • Microsurgical Instrumentation Overview

Catalogues essential microsurgical instruments, their design rationale, and proper handling. Familiarity with instruments reduces operative errors before hands-on training begins.

Lesson 3 • Physiology of Microvascular Flow

Explains haemodynamics, vasospasm, and thrombosis at the microvascular level. Understanding these principles guides intraoperative decision-making and postoperative monitoring.

Lesson 4 • Optical Magnification and Illumination

Introduces operating microscope optics, loupes, and lighting systems used in microsurgery. Correct equipment selection directly affects visualisation quality and surgical precision.

Lesson 1 • Suture Placement Geometry

Covers bite depth, spacing, and angulation for leak-free anastomoses. Geometric consistency across sutures is the foundation of patent vessel repair.

Lesson 2 • Instrument Tying Under Magnification

Teaches the square knot and surgeon's knot using needle holders under the microscope. Controlled tension and knot security are emphasised through repetitive bench-top drills.

Lesson 3 • Synthetic Model Suturing Practice

Applies suture and knot skills to silicone tubing and latex vessel models. Structured repetition on models builds muscle memory before animal or cadaver work.

Lesson 1 • Two-Stay-Suture Technique

Introduces the classic 180-degree stay-suture method for arterial anastomosis. This foundational approach establishes spatial orientation for all subsequent anastomotic methods.

Lesson 2 • Intraoperative Patency Testing

Establishes objective methods to confirm anastomotic patency before wound closure. Early detection of thrombosis or stenosis prevents flap loss and reoperation.

Lesson 3 • Ex Vivo Arterial Repair Practice

Transfers anastomosis skills to fresh cadaveric or animal vessel segments under supervision. Realistic tissue properties challenge and consolidate bench-top technique.

Lesson 4 • Vessel Preparation and Adventitia Removal

Teaches atraumatic vessel mobilisation, adventitia trimming, and luminal irrigation. Proper preparation prevents thrombosis and ensures accurate suture placement.

Lesson 1 • End-to-End Venous Anastomosis

Applies two-stay and triangulation methods to venous vessels with modified tension control. Consistent eversion and gentle tying prevent intimal infolding in thin walls.

Lesson 2 • Venous Thrombosis Recognition and Management

Identifies intraoperative signs of venous thrombosis and outlines salvage strategies. Prompt recognition and intervention are critical to free-flap survival.

Lesson 3 • Venous Wall Anatomy and Handling

Highlights structural differences between arterial and venous walls affecting suture behaviour. Gentle handling protocols prevent intimal damage and postoperative thrombosis.

Lesson 1 • Assessing Vessel Size Discrepancy

Quantifies acceptable mismatch ratios and identifies when standard repair is insufficient. Systematic assessment prevents choosing an inappropriate anastomotic configuration.

Lesson 2 • Techniques for Size Mismatch Correction

Covers fish-mouth spatulation, oblique cuts, and sleeve techniques to equalise lumen diameters. Each method is matched to specific mismatch severity and vessel type.

Lesson 3 • Coupler Device Anastomosis

Introduces mechanical coupling devices for venous and small arterial anastomosis as an alternative to hand-sewn repair. Coupler use reduces ischaemia time and anastomotic variability.

Lesson 4 • Vein Graft Harvest and Interposition

Teaches saphenous and cephalic vein harvest, preparation, and interposition for bridging vessel gaps. Proper orientation and tension-free placement are essential for graft patency.

Lesson 1 • Principles of Free-Flap Selection

Matches defect characteristics to flap type based on tissue composition, pedicle length, and donor morbidity. Systematic selection reduces complications and optimises functional outcomes.

Lesson 2 • Flap Inset and Pedicle Management

Executes tension-free flap inset, pedicle routing, and anastomosis sequencing for optimal perfusion. Correct pedicle geometry prevents kinking and venous obstruction after inset.

Lesson 3 • Recipient Site Preparation

Prepares the defect bed, identifies recipient vessels, and plans flap orientation before pedicle division. Thorough preparation minimises ischaemia time after flap transfer.

Lesson 4 • Preoperative Vascular Mapping

Uses Doppler ultrasound and CT angiography to locate perforators and plan safe harvest. Accurate mapping reduces intraoperative surprises and shortens dissection time.

Lesson 1 • Adjunct Monitoring Technologies

Reviews implantable Doppler probes, near-infrared spectroscopy, and tissue oximetry devices. Technology-assisted monitoring supplements clinical assessment in high-risk patients.

Lesson 2 • Postoperative Anticoagulation Management

Reviews anticoagulation regimens, monitoring parameters, and bleeding risk mitigation after free-flap surgery. Balanced anticoagulation reduces thrombosis without increasing haematoma risk.

Lesson 3 • Surgical Re-Exploration and Salvage

Outlines stepwise re-exploration, thrombectomy, and revision anastomosis for compromised flaps. Structured salvage protocols maximise the probability of flap rescue.

Lesson 4 • Recognising Arterial and Venous Compromise

Differentiates arterial insufficiency from venous congestion using clinical and device-based signs. Accurate diagnosis directs the correct salvage intervention without delay.

Lesson 1 • Microsurgical Nerve Repair and Grafting

Teaches epineural and fascicular nerve repair and sural nerve graft harvest for gap bridging. Precise coaptation alignment maximises axonal regeneration and functional recovery.

Lesson 2 • Lymphaticovenous Anastomosis

Introduces supermicrosurgical technique for lymphaticovenous anastomosis in lymphoedema treatment. Vessels under 0.8 mm require refined instrument control and specialised suture.

Lesson 3 • Digital and Limb Replantation

Covers patient selection, bone fixation sequencing, and multi-structure repair in replantation surgery. Replantation demands simultaneous mastery of vascular, nerve, and tendon repair.

Lesson 4 • Vascularised Composite Allotransplantation

Surveys the microsurgical principles underlying hand and face allotransplantation procedures. Students understand multi-vessel anastomosis sequencing and immunosuppression implications.