============================================================ Medicine: "Microsurgery: Sew Small"  Uploaded: March 1, 1987 ------------------------------------------------------------  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 better the  feeling in a damaged part of the face, or control in a previously useless arm. But the wounded and severed body part  must be treated carefully. If a small part of the body, such as a finger is cut off, instead of torn, wrapped in a clean  covering, put on ice and then reattached within a few hours, the chance of success is over ninety percent, as long as one good artery and one good vein can be reattached.  Not only is micro surgery allowing body parts to be reattached, it's also allowing them to be reshuffled. Before 1969,  nothing could be done for you if you'd had your thumb smashed  beyond repair. But in the past 14 years, you would have been in luck, if your feet were intact.  Every year in North  America, hundreds of big toes are removed from feet and  grafted onto hands. Sometimes tendons are shifted from less  important neighbouring fingers to allow the thumb to work  better in its unique role of opposing the other fingers and  allowing us to grip.   While we in North America can live without our big toes and  never really miss them, people in Japan can't. They need  their big toes to keep the common footwear, the clog, on  their feet. So their second toe is taken instead.  Farmers, labourers car accident victims and home handymen  are the people most often helped by microsurgery replants.  And because blood vessels are being reattached, burn victims can now benefit. Flaps of their healthy skin are laboriously reattached more successfully, blood vessel by blood vessel,  to increase chances that the graft will take. Some women,  whose diseased Fallopian tubes have become blocked, can have  them reopened microsurgically. When a cancerous esophagus  must be removed, it can be replaced using a section of the  person's own bowel. These people can then lead a more normal  life, using their mouth to eat with instead of inserting  food though a feeding tube in their stomach.  Doctors have been able to rebuild an entire lower face by  sculpting the lower jaw from living hip bone and covering it  with the skin from that piece of bone. In all, over seventy  parts of your body can be used as donor backups and recycled  into other damaged sites. And because your body won't reject  your own tissue - a constant hazard in transplants - in this  case, you are your own best friend.  In everyday use, however, microsurgery is proving to be a  miracle worker, large and small. We take for granted, for  instance, all the complex nerve and muscle control that goes  into a simple a gesture as smiling. But one young woman couldn't. An accident left her with a face that was damaged  and unable to smile.  Microsurgery reconnected severed nerves,  giving muscle control back to her face, restoring her looks  and giving her something to smile about.  