Microsurgery and perforator flap reconstruction

Microsurgery is intricate surgery that is performed under a specialised operating microscope on very small structures, such as blood vessels and nerves, with specialised instruments.

For a surgeon to perform microsurgery, extensive training and practice are required. Associate Professor Ch’ng is a fully trained Plastic and Reconstructive Surgeon who has undertaken specific additional training in microsurgery.

Microsurgical reconstruction, also known as free flap or free tissue transfer, is surgery to reconstruct wounds that cannot be closed by traditional methods such as suturing, skin grafts or local flaps. Utilising magnification up to twenty times that produced by the naked eye and stitches finer than a hair, Dr Ch’ng is able to join blood vessels and nerves that are less than 1mm in diameter.

Dr Ch’ng utilises microsurgery to reconstruct wounds that result from treatment for cancer (especially following surgery for head and neck cancer but also including other cancers), or wounds caused by trauma or disease. Examples of tissues that may be transferred with microsurgical techniques are skin, muscle, fat, bone, and intestine. She has expertise in the perforator flap technique, the most sophisticated form of free flap surgery where effects on the donor site are minimised. Perforator flap surgery, as compared with conventional free flaps, minimises damage to the underlying muscle including its innervation, and therefore, results in decreased postoperative pain and accelerated rehabilitation.

Following reconstructive microsurgery, you should expect to be in hospital for 5-10 days. You will be kept warm and adequately hydrated, and the surgical site will be monitored closely to assess colour, temperature, and blood perfusion. Doppler ultrasound technology, using high-frequency sound waves, may be used to evaluate the flow of blood to and from the surgical site.

It is important to appreciate that not all wounds require microsurgical reconstruction. Dr Ch’ng is trained in a wide range of surgical techniques, and will individualise the reconstructive surgical procedure based on your specific condition.