Microsurgery in Hand Surgery: What It Is & Why It Matters
Imagine needing a plumber to reconnect ultra‑tiny pipes in your hand—a job so delicate that only a specially trained mechanic can handle it. That’s what microsurgery is all about: using a microscope and ultra-fine tools to stitch together blood vessels and nerves no wider than a couple of millimeters.
What Exactly is Microsurgery?
Microsurgery is a surgical technique performed under a powerful microscope with very small instruments and sutures. It allows surgeons to repair or reattach tiny blood vessels and nerves, sometimes less than 1 mm in diameter, with incredible precision.1
Microsurgery is used for:
- Replantation: Reattaching amputated fingers, thumbs, or other parts
- Free tissue transfer (free flaps): Moving skin, muscle, bone, or fat from one part of the body to another, reconnecting the blood vessels so it survives1
- Nerve repair or nerve transfers
- Lymphedema surgery (for swelling due to lymphatic issues)1
Who Performs These Procedures?
Microsurgery is a highly specialized technique. Surgeons who perform it are usually hand surgeons with advanced training. Many are board-certified, which requires a full year of extra fellowship training in hand surgery beyond their primary specialty.2
When Is Microsurgery Needed?
Microsurgery is used when conventional repairs won’t cut it:
✅ Replantation (Reattachment)
If someone loses a finger or thumb, microsurgery can restore blood flow and reconnect nerves and tendons. Thumbs are almost always replanted because they’re essential to hand function.3
✅ Free Tissue Transfer (Free Flaps)
After serious trauma or cancer, large areas of skin or tissue may be missing. With free flaps, surgeons move tissue from another part of the body (like the thigh or abdomen) and reattach it using microsurgery to rebuild the hand or wrist.1
✅ Nerve Repair or Transfers
When a nerve in the hand is injured, surgeons can either repair it or reroute another nerve to restore some function. The precision required calls for microsurgical skill.1
✅ Lymphedema Surgery
For patients with swelling due to lymphatic issues, microsurgery can connect tiny lymph vessels to help drain fluid and reduce swelling.1
How to Prepare for Microsurgery
If your surgeon recommends microsurgery, you may need to:
- Have blood tests, possibly a heart tracing (EKG), or imaging, depending on your health
- Stop smoking for 3–4 weeks before and after the procedure, to promote healing
- Adjust medications with your surgeon’s guidance
- Maintain a balanced diet and exercise to prepare your body for recovery1
What to Expect During & After Surgery
Microsurgery procedures often take longer and usually require a hospital stay:
- Immediately after surgery, nurses need to monitor blood flow to the reattached tissue.
- Hospital stays can range from a few days to longer, especially after free flaps or replantation. Patients may stay in the ICU or a specialized unit for close monitoring.1
- Supportive care may include warming devices, blood flow medications, and avoiding nicotine.
Recovery also involves:
- Hand therapy with a certified hand therapist (CHT).
- Rehabilitation exercises to regain motion, strength, and sensitivity.
- Regular check‑ups with your surgeon.1
Why Is Microsurgery Such a Big Deal?
Microsurgery has changed the game in hand reconstruction. Even a single finger can make a major difference in grip and coordination. With microsurgery, restoring appearance and sensation is often possible. Advanced techniques now include toe-to-thumb transfers, complex free flaps, and refined nerve grafts that were once impossible.3,4 Medical journals are regularly publishing advances in these procedures, helping surgeons around the world improve outcomes for patients.4
How to Know If Microsurgery is Right for You
Not every injury or condition requires microsurgery. Your hand surgeon will consider:
- Which body part is injured
- How long it has been since the injury
- Whether microsurgery will improve function
- Your overall health and ability to go through surgery and rehabilitation1
Your surgeon will also discuss “plan B” options in case the reattachment or transfer doesn’t fully succeed.
If you or a loved one is facing a hand injury, speak with a hand surgeon. They will help you understand your options and guide you through the recovery process.
This blog was reviewed by a certified hand surgeon for accuracy.
Microsurgery. Handcare.org. https://www.assh.org/handcare/condition/microsurgery.
About ASSH. American Society for Surgery of the Hand. https://www.assh.org/.
What is Replantation? Handcare.org. https://www.assh.org/handcare/blog/what-is-replantation
Mehrzad R, Prsic A, Basta M, Bhatt R. A Cross-Sectional Survey Study among Hand Surgeons in the United States on Standardizing Microsurgery Training. J Hand Microsurg. 2019 Apr;11(1):35-44.