Monday, May 3, 2010

Microsurgery History

Facial transplants, hand replants, free flaps are only possible in large part due to microsurgery.  I finally got around to reading the “History of Microsurgery” this past week (first full reference below).  The article, as well as the other two, are good reading for anyone interested in the history of microsurgery. 

The article, written by Susumu Tamai, M.D., Ph.D. (Japan) was received for publication June 14, 2007.

Microsurgery is relatively young.  Dr. Tamai breaks down the history to four periods:

  • Dawning Period of Microsurgery (end of the 1950s to 1970)
  • Developing Period of Microsurgery (1971 to 1980)
  • Fully Matured Period of Microsurgery (1981 to 1997)
  • Transition Period from Autogenous to Allogenic Transplantation and Regenerative Medicine (1998 to 2007)

 

As the article points out microsurgery hinged on many other medical/surgical/technology discovers.  A few of them mentioned include:

    • The most significant technical breakthrough came in 1902, when Alexis Carrel reported the triangulation method of end-to-end anastomosis that is still routinely used today and for which he was later awarded the Nobel Prize in 1912.
    • The introduction of anticoagulation was one of the critical developments in clinical vascular surgery. Heparin was discovered in 1916 by Jay McLean, a medical student at Johns Hopkins University, and Howell and Holt.   The ability to control blood clotting was an essential step forward in the development of microvascular surgery.
    • The final innovation that laid the foundation for modern microvascular surgery was the introduction of the operating microscope by Nylen and Holmgren in the early 1920s at the Karolinska Medical School in Stockholm, Sweden. It was used successfully in ear and eye surgery at various centers in Europe.

A few key landmarks from the article:

  • Jacobson and Suarez  are credited with the landmark achievement of successful microvascular anastomosis using an operating microscope in 1960….  Finally, he brought in an operating microscope used for otology and was successful. This event marked the historical beginning of microvascular surgery.
  • In 1962, Malt and McKhann performed the first replantation of a completely severed arm in a 12-year-old boy in Boston.
  • The year 1965 was an eventful year in the field of microsurgery. The first reported experimental free skin flap transplantation of abdominal skin based on the superficial epigastric vascular pedicle was performed in a dog by Krizek and associates.
  • In November of 1967, the world’s first panel on microsurgery was held at the Annual Meeting of the American Society of Plastic and Reconstructive Surgeons in New York City. The panelists included Harry Buncke, John Cobbett, James Smith, and Susumu Tamai, with Clifford Snyder serving as moderator. This was a landmark event in the history of microsurgery.
  • With increasing interest in microsurgery among orthopedic and plastic surgeons in the United States, the American Society of Reconstructive Microsurgery was founded in 1983, 11 years after the establishment of the International Society for Reconstructive Microsurgery. The members of the founding council included James Steichen, Berish Strauch, Julia Terzis, James Urbaniak, and Alan Van Beek. The first meeting was held in Las Vegas in 1985 under the presidency of Berish Strauch, with approximately 300 orthopedic and plastic surgeons attending. Since then, the meeting has been held once a year at several locations in the United States.
  • The era of allotransplantation of composite tissues began with hand transplantation at the end of the twentieth century. The first procedure was performed on a 48-year-old man on September 23, 1998, in Lyon, France, by Dubernard and his team.
  • After these successes, on November 27, 2005, the first facial allotransplantation, including nose, lips, and chin, was performed on a 38-year-old woman who had suffered a dog bite injury on the lower face in June of 2005.

 

 

 

REFERENCES

History of Microsurgery; Tamai, Susumu; Plastic & Reconstr Surgery, 124(6S):e282-e294, December 2009; doi: 10.1097/PRS.0b013e3181bf825e

Correction: History of Microsurgery; Plastic & Reconstr Surgery, 125(3):1050, March 2010; doi: 10.1097/PRS.0b013e3181d91a45

The Early History of Microsurgery; Buncke, Harry J.; Buncke, Gregory M.; Kind, Gabriel M; Plastic and Reconstructive Surgery, 98(6):1122,1123, November 1996.

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