New era of reconstructive microsurgery.

Hopfner performed the first successful experimental limb replantation in 1903, and Malt performed the first successful clinical replantation for an above-elbow amputation in 1962. Since then the range of applications for reconstructive microsurgery has expanded rapidly, and it is now widely used for repair of nerves, vessels and lymphatics. In 1972 the first successful case of free flap transfer was performed. Many new applications followed including: (1) coverage of extensive wound defects with exposure of bones, joints, tendons and major vessels which can not be covered with local tissue; (2) vascularized bone transfer for bone defects; (3) vascularized joint transfer for hand joints and the temporomandibular joints; (4) functioning muscle transfer to replace the muscles of the upper limbs and face; (5) toe transfer for missing fingers and thumbs; (6) reconstruction following tumor ablation; (7) reconstruction of congenital anomalies; (8) reconstruction of chest, pharynx and cervical esophagus; (9) transfer of gliding tissue, fascia and sensory flaps for certain injuries. The goals of future reconstructive microsurgery include refinement of procedures, enhancement of functional and aesthetic results, and minimization of the morbidity of donor sites. Improvements of instruments, sutures and computer imaging systems will enable surgeons to perform more accurate reconstructions. Endoscopic harvesting of flaps will be widely used. Surgery will be performed on newborns with certain congenital anomalies. Microsurgery will be increasingly used in conjunction with a prosthesis to improve the function of the prosthesis. Microarthroscopy will be used in operations involving small joints. Advances in microsurgery techniques may also change the results of vascular surgery and tumor resection.