Welcome

Indian Society for Reconstructive Microsurgery

Microsurgery constitutes a pivotal advancement within reconstructive plastic surgery, with applications spanning numerous surgical specialties that necessitate precise reconstruction. Surgeons specialising in microvascular procedures, especially those in plastic surgery, have played an instrumental role in the discipline’s global progress.

The use of magnification in operative surgery can be traced back to 1929, when ENT surgeon Ziel Nelson introduced a basic operative microscope to enhance visualisation of middle ear structures. This innovation prompted reconstructive surgeons to investigate novel techniques, such as tissue transfer between body sites. To ensure viability of these grafts, surgeons developed methods for restoring blood flow by joining arteries and veins at the recipient site under magnification.

Significant foundational work in microsurgery is credited to Alexis Carrel, recipient of the Nobel Prize in Medicine (1908), who successfully reattached a dog’s severed neck by suturing the vessels. This achievement established essential principles that would drive future developments in microsurgical practice.

For an extended period, microsurgical procedures were limited to experimental settings. During this time, advancements focused on refining operative microscopes for improved magnification, creating finer suture materials, and developing more precise instruments to enable intricate surgical tasks.

Critical milestones include Dr Harry J Buncke’s successful transplantation of living omentum to cover an exposed brain in the United States (1963), Harold Klienert’s revascularisation of a partially amputated thumb in Louisville (1964), and Ian Taylor’s first documented free tissue transfer at Royal Melbourne Hospital, Australia (1973). These achievements marked the transition from experimental procedures to effective clinical application in microsurgery.

India’s contributions date to 1969, when Professor C. Balakrishnan performed reimplantation of a near-total hand amputation at the wrist in Nagpur, utilising polythene cannulae to connect radial and ulnar vessels; the procedure achieved overall success except for the thumb’s survival. In the late 1960s, Dr Antia and Buch attempted the first free tissue transfer in India, though only partially successful.

In 1974, Dr Ashok Sen Gupta, Orthopaedic surgeon and inaugural president of the Indian Society for Surgery of the Hand (Kolkata), accomplished the country’s first successful thumb replantation, and he subsequently managed a considerable series of hand replantations. In the late 1970s, the Department of Plastic Surgery at Stanley Medical College, Madras, initiated experimental microvascular surgical work, illustrated by Dr Peter Nathan demonstrating microanastomosis of rat vessels under the microscope. Initial efforts at Stanley were confined to experimentation, but in 1980, they achieved both the first successful thumb replantation and the first free vascular tissue transfer for secondary thumb reconstruction using a wrap-around flap from the great toe, as described by Wane Morrison (Melbourne).

By the late 1980s, several young plastic surgeons trained abroad began microsurgical procedures upon returning to India. In the early 1990s, following retirement from Stanley Hospital, efforts commenced to establish a national platform—the Indian Society for Reconstructive Microsurgery—for sharing expertise in the field. The inaugural microvascular surgery workshop was organised in 1992, with Dr G. Balakrishnan as organising secretary. Twenty-seven practicing microsurgeons contributed to founding the society, which was formalised with elected office bearers.

Thus, the INDIAN SOCIETY FOR MICROSURGERY was established.