Reconstructive surgery is performed to replace body structures that are affected functionally or aesthetically by cancers, infection, trauma and developmental abnormalities. This can be done to improve function but may also be performed to restore aesthetic appearance of the structure. Reconstructive surgery is covered by most health insurance plans, although coverage varies according to the different plans and the level of coverage may vary for different procedures. Drop our team an email today if you would like to find out more about your procedure or coverage.

Reconstructive microsurgery is a sub-specialty within Plastic Surgery in which specialized operating microscopes and precise instruments are used to assist in the repair of very fine structures such as blood vessels and nerves, which are less than a few millimeters in diameter. The development of this field has made a major impact to restore form and function to individuals impaired by trauma, cancer and congenital abnormalities. With the use of microsurgery, plastic surgeons are able to transfer tissue (free tissue transfer) from one part of the body to another, reattached amputated body parts and composite tissue transplantation.

Microsurgery represents the pinnacle of plastic surgery development and typically reserved for complex reconstructive surgery problems where the other options, such as skin grafts or local flaps are inadequate. Our surgeons at AZATACA Plastic Surgery are all sub-specialty trained in microsurgery at the Singapore General Hospital and are comfortable with offering you the full range of services to meet your requirements.

Our doctors at AZATACA Plastic Surgery are trained to offer the full range of reconstructive surgery with sub-specialty expertise in breast reconstruction after cancer surgery. The other common microsurgery procedures that are provided include:

• Head & Neck Reconstruction using free tissue transfer
• Lower Limb Salvage using free tissue transfer 
• Lymphatic Reconstruction & Lymph Node Transfer for Lymphedema
• Abdominal Wall & Perineal Reconstruction 
• Vascularised Bone Flap Transfer
• Nerve Repair & Grafting

At AZATACA Plastic Surgery, we believe in a holistic team approach with the patient as the centre of our focus. Our surgical philosophy is aimed at restoring function and improving quality of life. Most of our patients requiring reconstructive surgery would have already or will be undergoing surgery to remove some critical parts of their body. We understand that it is daunting to have to undergo further reconstructive surgery. Whilst reconstructive surgery is complex, we believe that with a team of three surgeons, we are able to provide you total coverage on all days of the year and the shortest operative time so that you can recover within the quickest time and return to normal daily life and work.

Free tissue transfer involves taking tissue from one part of the body and transferring it to another part of the body. The blood vessels (artery and vein) will have to be anastomosed to ensure survival of the tissue at the new transfer site. The tissue transfer can be of a single component e.g. skin and fat or including other tissue types such as skin, fat and bone or skin, fat and nerves. 

Step 1 – General Anaesthesia. Microsurgery procedures are usually done under general anaesthesia due to the extended duration of surgery and the complex technical nature. Medications will be administered to help you to be comfortable during surgery.

Step 2 – The incision. Free tissue transfer involves taking tissue, tiny blood vessels, and nerves from a donor site and transferring it to a recipient site. This is done simultaneously at AZATACA Plastic Surgery to reduce your total anaesthesia time. First, the recipient site is prepared after removal of the scar or cancer. Simultaneously, the second team performs surgery at the donor site to prepare the flap for tissue transfer. Once the recipient site is prepared, the flap is transferred for anastomosis and the second team proceeds to close the donor site. 

Step 3 – Closing the incisions. Based on your surgical plan, your incisions may be closed with removable sutures, skin tissue glue or sutures that dissolve on its own.

Step 4 – Recovery and Transfer to the High-Dependency Ward

After the surgery is complete, your surgeon will ensure that you are safely transferred to your bed and you will be monitored critically during the first 24-48 hours to ensure that if there is any flap complications, we can bring you back to the Operating Theater for exploration.

No surgical procedure is without risk. A discussion of all potential benefits and complications should be done during consultation with our FAMS-certified plastic surgeons. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.

The possible risks of microsurgery include, but are not limited to:

• Bleeding
• Infection / Bruising / Hematoma
• Scars at both the donor and recipient sites
• Flap failure which can be partial or complete

     - Skin loss or tissue necrosis

     - Fatty tissue found deep in the skin might die (fat necrosis)

• Asymmetry 
• Numbness or other changes in skin sensation
• Fluid accumulation (seroma)
• May require revision surgery
• Anaesthesia risks
• Other conditions related to but not due to the primary surgery

     - Cardiac and pulmonary complications

     - Deep vein thrombosis

These risks and others will be fully discussed prior to your consent. It's important that you address all your questions directly with your plastic surgeon.

• Are you an Academy of Medicine Singapore certified Plastic Surgeon?
• Were you trained specifically in the field of microsurgery during your training?
• What specific training do you have in microsurgical techniques?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? 
• Am I a good candidate for this procedure?
• Where and how will you perform my procedure?
• What options are available for me and which will be the ideal surgical technique?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• What kind of potential complications can I expect?
• How can I expect the results of my procedure to look over time?
• What are my options if I am dissatisfied with the outcome?
• Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me? As we are not allowed to advertise before-after photos online, please drop us an email or arrange a consultation to find out more.

Artery - Blood vessel sending blood away from the heart.

Vein - Blood vessel return blood to the heart.

Anastomosis – The joining of two blood vessels using sutures.

Donor site - An area of your body where the surgeon harvests skin, fat, muscle, and/or bone to reconstruct another area of the body.

Free flap / free tissue transfer - Tissue isolated on specific blood supply that is removed from one area of the body and transplanted to another area of the body with vascular repair.

Local flap - Tissue with an intact blood supply that is lifted from a donor site and moved to an adjacent recipient site without detaching blood vessels.

Skin graft - Healthy skin is removed from one area of the body and relocated to the wound site.

Vasospasm - Narrowing of the blood vessels.