[Vascular microsurgery and progress of free flap surgery].

In 1960 Jacobson and Suarez realized and described the first vascular microanastomosis. They introduced microsurgical operating technique, improved instrumentation and operating microscope. Many improvements were tried: vascular intubation, laser, biological glue, microvascular anastomotic system, non transfixing microstaples. After expert's report, these techniques have shown many drawbacks and have not supplanted the manual anastomosis. The failure rate was 6.6% in a review of 9,503 cases from the literature. The rate of vascular thrombosis decreased when subcutaneous heparin was administered in the post-operative period. Microvascular surgery has become an important method for reconstructing complex surgical defects by using free vascularized transplants. The majority of free flaps were applied to the reconstruction of defects resulting from tumor ablation or trauma. The recipient sites were mainly distributed to the head and neck and to the limbs. Reconstruction of an irradiated recipient site is a significant predictor of failure. The vascular microsurgery using thread and needle requires a strict training with an important invested time.