Chunlin Hou - Practical Microsurgery Cases: Repair, Replantation and Reconstruction

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The use of the operating microscope created many new possibilities in surgery. Initially, most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a great technique suitable for more applications [13]. Anatomic research of the blood supply of skin, fascia, nerve, muscle, and bone identified flaps could be carried by pedicle vessels. Transfer of these flaps and revascularization by microvascular anastomoses of the arteries and veins set the stage for free flaps. With free flap surgery, single-stage and complex reconstructions could be achieved, which then led to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microsurgical technique is fully matured, and microvascular free tissue transfer is an essential part of reconstructive surgery.

Microsurgery was born in China [417]. In the early growing stage of microsurgery, four great achievements were performed by Chinese surgeons. The first successful distal forearm replantation in the world in January 1963 by Dr. Zhong-Wei Chen and coworkers in Shanghai Sixth Peoples Hospital, the first successful second toe-to-thumb transplantation in February 1966 by Drs. Dong-Yue Yang and Yu-Dong Gu in Shanghai Huashan Hospital, the third free flap (lower-abdomen flap nourished by superficial epigastric artery and vein) transfer in the world in March 1973, also by Drs. Yang and Gu, and the first neurovascular pectoralis major (abdomen part) free transfer in July 1973 by Dr. Zhong-Wei Chens group.

However, there were very restricted scientific exchanges with the Western world before Chinas Open Policy in the 1980s. Some western surgeons or groups visited China occasionally and introduced Chinese achievements sporadically in western English journals. In the last 20 years of the twentieth century, the exchanges were still limited because of the lack of financial support and barrier of foreign language. Only a small number of Chinese surgeons had the opportunity to attend international meetings and present their works, and still only a small number of authors could publish their papers in English in the Western medical journals, or in the English edition of Chinese Medical Journal, which was the only English periodical pressed by Chinese Medical Association before the 2000s. Therefore, many original works by Chinese investigators in microsurgery are unknown to the world.

In the twenty-first new century, microsurgery has been practiced widely and extensively throughout the country, in both university hospitals in big cities and county hospitals in rural areas [1821]. The aim of this English compilation is to introduce some novel or sophisticated microsurgical techniques and applications in the pattern of illustrative case presentations, including almost all the spectrum of microsurgery, from head and neck, upper limb and hand, to lower limb and foot, for example, digit replantation, toe-to-hand transplantation, peripheral nerve injuries, surgical flaps, bone and joint, and tumor resection and microsurgical reconstruction.