Microsurgery in the 20th century enabled surgeons to
operate on very fine structures. Nylen (1892–1978),1 performed
the first ear operation in a human in November
1921. Holmgren (1875–1954), modified Nylen’s idea by
utilizing a binocular Zeiss microscope in 1922.2 Other
specialities (neurosurgery or plastic and reconstructive
surgery) only adopted microsurgical instruments and techniques
in the 1960s. One of the more important events in
the development of microsurgery was the anastomosis of
blood vessels with diameters between 1.6 and 3.2 mm by
Jacobson and Suarez in 1960, with a relatively high rate
of postoperative patency.2 Microsurgical technique is now
extensively used in all realms of surgery. It is applied in
two broad fields: in transplantation with vascular anastomosis
of various free tissues, including the omentum,
segments of intestine, muscles, bones, joints, skin, and
subcutaneous tissues, and in branches of surgery, such as
cardiovascular surgery, brain surgery, urology, obstetrics
and gynecology, and surgery of the lymphatic system.3
Reconstructive microsurgery has progressed from its initial
ability to achieve wound coverage using free tissue
transfer to a new level of sophistication with regard to
restoration of function and aesthetics when dealing with
acquired or congenital problems in all body regions. The
ability to select an optimal reconstructive procedure using
suitable donor tissue and to transfer this tissue directly to
the sites of tissue and/or functional defects has permanently
altered many reconstructive methods and has
expanded the indications for microsurgery. Advances in
anatomy, concerning vascular and nerve supply, established
the unique role of free tissue transfer in reconstructive
surgery. As the success rate of free flaps has
improved, in my personal experience, to above 90%,
indications for these procedures have changed from a last
resort reconstructive option to one that achieves the best
reconstruction possible. The goal in the reconstructive
microsurgery is to obtain the best possible result according
to the functional and aesthetic outcomes, with minimal donor
site morbidity. It is known that the major role of free
flaps is the coverage of difficult wound caused by severe
injury, burns, tumor resection; however, after the first successful
functioning neurovascular muscle transfer on experimental
animals in 1970, the work in this area has led to
exciting concepts on the capability of functioning muscle
transfer to restore facial expression, to improve extremity
flexion or extension, to augment cardiac compression, or
to replace paralyzed bladder detrusor