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Medicine Microsurgery: Sew Small

Medicine: "Microsurgery: Sew Small"

A man came into the emergency ward at one o'clock. His thumb came in an hour later. The surgeon's job: get them back together.

The successful re-attaching of fingers to hand requires long hours of painstaking work in microsurgery. In the operating room , the surgeon doesn't stand, but sits in a chair that supports her body. Her arm is cradled by a pillow. Scalpels are present as are other standard surgical tools, but the suture threads are almost invisible, the needle thinner than a human hair. And all the surgical activity revolves around the most important instument, the microscope.

The surgeon will spend the next few hours looking through the microscope at broken blood vessels and nerves and sewing them back together again. The needles are so thin that they have to be held with needlenosed jeweller's forceps and will sew together nerves that are as wide as the thickness of a penny. To make such a stitch, the surgeon's hands will move no more than the width of the folded side of a piece of paper seen end on!

Imagine trying to sew two pieces of spaghetti together and you'll have some idea of what microsurgery involves.

Twenty-five years ago, this man's thumb would have been lost. But in the 1960s, surgeon's began using microscopes to sew what previously had been almost invisible blood vessels and nerves in limbs. Their sewing technique had been developed on large blood vessels over a half century earlier but could not be used in microsurgery until the needles and sutures became small enough. The surgical technique, still widely used today, had taken the frustrating unreliability out of sewing slippery, round-ended blood vessels by ingeniously turning them into triangles. To do this, a cut end of a blood vessel was stitched at three equidistant points and pulled slightly apart to give an anchored, triangular shape. This now lent itself to easier, more dependable stitching and paved the way for microsurgery where as many as twenty stitches will have to be made in a blood vessel three millimetres thick. The needle used for this can be just 70 millimetres wide, only ten times the width of a human blood cell.

All this technology is focused on getting body parts back together again successfully. The more blood vessels reattached, the better the survival chances for a toe or a finger. The finer the nerve resection, the...

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