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The treatment of facial palsy is a complex and challenging area of plastic surgery. Microsurgical innovation has introduced the modern age of dynamic reconstruction for facial palsy. This review will focus on microsurgical reconstruction for smile restoration in patients with long-standing facial palsy. The most common donor muscles and nerves will be presented. The advantages and disadvantages of single-stage versus multi-stage reconstruction will be discussed. Contemporary trends will be highlighted and the authors' preferred practice outlined., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use., Methods: Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates., Results: There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies., Conclusion: Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/3M™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-Clip®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques., (Copyright © 2011 Wiley-Liss, Inc.)

Authors report over 30 years of their own clinical experience in the treatment of chronic peripheral lymphedemas by microsurgical techniques performed at the Center of Lymphatic Surgery of the University of Genoa, Italy. Over 1,500 lymphedema patients were treated with microsurgical techniques. Derivative lymphatic-venous techniques were most often used. For those cases where a venous disease was associated to lymphedema, reconstructive lymphatic microsurgery techniques were performed (lymphatic-venous-lymphatic-plasty). Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Volume changes showed a significant improvement in over 83%, with an average follow-up of more than 10 years. There was an 87% reduction in the incidence of cellulitic attacks after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonoperative treatment. Improved results can be expected with operations performed at earlier lymphedema stages., (Copyright (c) 2007 Wiley-Liss, Inc. Microsurgery 2007.)

Experimental research faces two great problems: the significant reduction of public funding and the firm opposition of the public opinion. The law forbids the use of large animals, so that it is possible to use small animals only, which require microsurgical techniques. However, even a skillful surgeon does not know how to perform microsurgery and has to begin a long and tiring training to master techniques. We think that experimental surgery should play a role because it tests the validity and safety of new surgical techniques and allows special pathophysiological aspects to be studied. Furthermore experimental surgery could represent an essential stage in the training of young surgeons. We should find a balance between observance of the law and respect of the animals and, on the other hand, the role of experimental surgery because we should not forget that its most important aim is the improvement of the health of the humankind.

With the development of microsurgery and molecular biology in the 1990s, the mouse model for organ transplants has become increasingly popular. In the past 10 years, the number of studies using the mouse model has increased three-fold. All the organ transplants, originally done in the rat model, can now be performed in mice with high success rates. This article reviews the development, advantages, limitations, and unique immunology of the mouse model as well as future prospects.

The development of extremity replantation and reconstructive microsurgery was initially carried out independently among the pioneering centers throughout the world. The comparative development of these techniques is outlined. With the fast growth of microsurgical procedures, many of the U.S. residency programs have incorporated microsurgery training into the curriculum.

For more than two decades, microsurgery has been developed, practiced, and refined in China. For the most part, this has taken place independent of a parallel process in the Western World. Only until recent years has there been some communication from China regarding this microsurgical experience. The authors believe that there is much yet to be learned from the wealth of Chinese experience in microsurgery, just as Chinese surgeons have gained valuable information from the West. The authors reviewed the microsurgical literature in China from 1983 to 1986, and present here what we regard to be of particular interest to American microsurgeons, including the areas of digital reconstruction, replantation, flap transfer and transposition, and microsurgical techniques and patient management. Some historical background in the development of Chinese microsurgery is also provided.