Ghatkopar (East), Mumbai)
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Microsurgery In Mumbai
Expert Microscope-Guided Surgery for Nerve Repair, Vessel Anastomosis, Digit Replantation, and Free Tissue Transfer
Microsurgery is the performance of delicate surgical procedures on very small structures - blood vessels, nerves, lymphatics, and tendons - using an operating microscope and specialised micro-instruments and sutures finer than a human hair. At Shree Hospitals, our specialist microsurgeons perform the full range of microsurgical procedures including free tissue transfer (free flaps), digit and limb replantation, peripheral nerve repair and grafting, lymphaticovenous anastomosis (LVA) for lymphoedema, and toe-to-hand transfer - procedures that restore function, save limbs, and transform lives.
Severed Digit or Limb? Emergency Replantation Available 24 Hours at Shree Hospitals
Quick facts
Procedures: Replantation, Free Flap, Nerve Repair, LVA, Toe Transfer
Magnification: 6x to 40x operating microscope
Suture Size: 9-0 to 11-0 nylon (finer than human hair)
Anaesthesia: General or Regional Anaesthesia
Duration: 3 to 12 hours (procedure dependent)
Support Team: Microsurgeons, hand surgeons, physiotherapists
Key Benefit: Restoration of function not achievable by any other technique
What is Microsurgery?
Microsurgery encompasses any surgical procedure that requires the use of an operating microscope to visualise and work on structures that are too small to be operated on with the naked eye. In practice, this most commonly means blood vessels ranging from 0.5mm to 3mm in diameter and peripheral nerves from 1mm to 5mm in diameter. The operating microscope provides 6x to 40x magnification and allows the surgeon to perform precise anastomoses (connections) and repairs using sutures of 9-0, 10-0, or 11-0 nylon - sutures thinner than a human hair. The field of reconstructive microsurgery was pioneered in the 1960s and has since transformed the possibilities of reconstructive surgery, hand surgery, and lymphoedema management.
The main clinical applications of microsurgery include: free flap reconstruction (transferring composite tissue from a donor site to a recipient site with microsurgical vessel anastomosis); replantation surgery (reattaching a completely or partially severed digit, hand, or limb); peripheral nerve repair and grafting (reconnecting severed nerves to restore sensation and motor function); toe-to-hand transfer (transferring a toe and its blood supply to replace a missing thumb or finger); and lymphaticovenous anastomosis (LVA) (connecting lymphatic channels directly to small veins to bypass lymphatic obstruction in lymphoedema). Each application requires the same core microsurgical skill set but applies it to different clinical scenarios with different goals.
At Shree Hospitals, our microsurgery programme is one of the most comprehensive in Mumbai, offering 24/7 emergency replantation for traumatic amputations, elective free flap reconstruction for cancer and trauma defects, nerve reconstruction for peripheral nerve injuries, and LVA surgery for upper and lower limb lymphoedema. Our microsurgeons train and practice on a dedicated microsurgical simulator and maintain high-volume operative experience to sustain the technical precision that microsurgery demands.
Who Needs Microsurgery?
Microsurgery is indicated for:
- Traumatic digit or limb amputation - complete or near-complete severance of fingers, thumbs, hands, or limbs (emergency replantation)
- Complex reconstructive defects after cancer surgery, radiation, or trauma requiring free flap reconstruction with microsurgical vessel anastomosis
- Peripheral nerve injuries - complete nerve division from trauma (lacerations, crush, gunshot, traction) requiring nerve repair or nerve grafting
- Brachial plexus injuries from severe traction trauma - requiring nerve transfers or free muscle transfer for motor reinnervation
- Upper or lower limb lymphoedema (primary or secondary to cancer surgery or radiation) amenable to LVA surgery or VLNT (vascularised lymph node transfer)
- Thumb amputation or absence - treated with toe-to-thumb transfer (great or second toe transfer) to restore pinch and grip function
Is Microsurgery Right for You?
Microsurgery is appropriate when:
- The amputated part is viable for replantation (clean amputation, adequate ischaemia time, appropriate patient age and digit/part involved)
- The reconstructive defect involves exposed critical structures (bone, tendon, joint, neurovascular structures) or an irradiated bed where free flap is the only option
- Nerve continuity has been disrupted and spontaneous recovery without surgical repair is not anticipated based on the level and mechanism of injury
- Lymphoscintigraphy has confirmed patent lymphatic channels at the planned LVA site in the lymphoedematous limb
- The patient is medically fit for a prolonged procedure under general or regional anaesthesia
Why Microsurgery Restores What No Other Surgery Can?
Microsurgery achieves outcomes impossible by any other technique:
- Replantation restores a living digit or limb - no prosthesis can fully replicate the sensation, fine motor control, and natural appearance of a replanted digit
- Free flap reconstruction allows defect repair anywhere in the body using the optimal tissue type, including sites where no other reconstruction is possible
- Nerve repair and grafting enables recovery of sensation and motor function in nerve injuries that would otherwise result in permanent loss
- Toe-to-thumb transfer restores a functional pinch grip with a living, sensate digit in patients who have lost the thumb - the most important digit for hand function
- LVA surgery reduces limb swelling, reduces infection risk, and improves quality of life in lymphoedema patients by creating a new pathway for lymphatic drainage
Shree Hospitals achieves a free flap success rate of over 98% and offers 24/7 emergency microsurgery for replantation cases.
Our microsurgery team at Shree Hospitals maintains the highest standards of technical precision through dedicated training, high operative volume, and rigorous post-operative flap monitoring protocols, delivering outcomes that match international centres of excellence in reconstructive microsurgery.
24×7 Emergency Care
Our Approach to Microsurgery
At Shree Hospitals, microsurgery is performed by a dedicated team of trained microsurgeons with high individual operative volumes. We maintain a 24/7 on-call microsurgery service for emergency replantation cases and offer the full range of elective reconstructive microsurgery across all clinical indications.
24×7 Emergency Care
Emergency Replantation Service
Traumatic digital and limb amputations are time-critical emergencies. Replantation is most successful when performed within 6 hours of warm ischaemia (or up to 12 hours of cold ischaemia if the amputated part is correctly cooled). Our emergency microsurgery team is available 24 hours a day and is activated immediately when a replantation candidate presents to the emergency department. The amputated part is assessed for replantability based on the level and mechanism of amputation,
Free Flap Reconstruction
Our microsurgeons perform the full range of free tissue transfer procedures for reconstructive defects. Common free flaps performed at Shree Hospitals include: the ALT (anterolateral thigh) free flap for head and neck, extremity, and perineal reconstruction; the DIEP (deep inferior epigastric perforator) free flap for breast reconstruction; the fibula osteocutaneous free flap for jaw and long bone reconstruction; the radial forearm free flap for oral cavity and pharyngeal reconstruction; and the latissimus dorsi free flap for chest wall and scalp defects.
Peripheral Nerve Reconstruction
Peripheral nerve injuries resulting in loss of sensation or motor function are reconstructed using direct nerve repair (primary epineural or fascicular repair under the microscope) where the nerve ends can be approximated without tension, or nerve grafting using the sural nerve (harvested from the calf) where a gap exists. For brachial plexus injuries, our team performs nerve transfers (using expendable donor nerves such as the intercostal nerves, the medial pectoral nerve, or Oberlin's transfer) to reinnervate paralysed muscles and restore function.
Lymphaticovenous Anastomosis
(LVA) for Lymphoedema LVA surgery is a minimally invasive supermicrosurgical procedure in which lymphatic channels (0.3 to 0.8mm diameter) are anastomosed directly to subdermal venules under 25x to 40x magnification using 11-0 nylon sutures. This creates a new pathway that bypasses the obstructed lymphatics and allows lymphatic fluid to drain directly into the venous system, reducing limb swelling. Pre-operative lymphoscintigraphy and indocyanine green (ICG) lymphography map the functioning lymphatic channels and guide the operative sites.
Top Microsurgeons and Reconstructive Specialists
Every specialist at Shree Hospitals is board-certified and has an average of 15+ years of clinical experience in free flap microsurgery, digit replantation, peripheral nerve reconstruction, lymphaticovenous anastomosis, and toe-to-hand transfer.
24×7 Emergency Care
Dr. Suyash Yashwant Patankar
Consultant Plastic, Reconstructive
Dr. Arun V. Sheth
Consultant Plastic, Cosmetic
Dr. Abhijeet Dharmaji Sawant
Consultant Plastic, Reconstructive, Aesthetic
Dr. Udit Dalmia
Consultant Plastic, Aesthetic
Plastic and Reconstructive Surgery Services At Shree Hospitals
We offer a comprehensive range of plastic and reconstructive surgery procedures including microsurgery, flap surgery, skin grafting, breast reconstruction, cleft repair, scar revision, wound debridement, and functional rhinoplasty, all delivered by specialist plastic and microsurgeons.
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Step by Step Process of Microsurgery at Shree Hospitals
Step 1 - Assessment and Pre-Operative Planning
For elective microsurgery (free flap, LVA, nerve grafting), detailed pre-operative assessment includes CT angiography with perforator mapping for free flaps, lymphoscintigraphy and ICG lymphography for LVA cases, and nerve conduction studies / EMG for nerve reconstruction planning. For emergency replantation, assessment in the emergency department takes priority over investigation - the amputated part is kept moist and cool, the patient is resuscitated, and the replantation decision is made by the on-call microsurgery team based on clinical assessment of the amputation level, mechanism, and part viability.
Step 2 - Anaesthesia and Patient
Positioning General anaesthesia is used for all major microsurgical procedures. Regional anaesthesia (brachial plexus block) is added for upper limb replantation to provide vasodilation of the vessels and postoperative pain control. The patient is positioned to allow simultaneous access to both the recipient site and the donor site (for free flap) or to the amputation stump and amputated part (for replantation) to minimise operative time.
Step 3 - Vessel, Nerve, and Tissue Preparation
Under the operating microscope, recipient and donor vessels are prepared by trimming the vessel ends back to healthy, undamaged intima. Adventitia (the outer vessel wall) is cleared from the last 3 to 5mm of each vessel end. The vessel ends are dilated with vascular dilators and irrigated with heparinised saline. For nerve repair, nerve ends are trimmed back to healthy fascicles under magnification. For free flap harvest, the perforators are dissected under the microscope before division of the pedicle.
Step 4 - Microsurgical Anastomosis
The arterial anastomosis is performed first using interrupted 9-0 or 10-0 nylon sutures placed under the operating microscope, followed by the venous anastomosis (using the same technique or a venous coupling device for larger veins). The clamps are released, blood flow is observed, and patency is confirmed with the strip test (emptying the vessel and observing refill from both directions). For replantation, the sequence is bone fixation, then artery, then vein. For nerve repair, epineural sutures of 9-0 nylon are placed to approximate the nerve ends.
Step 5 - Wound Closure and Monitoring Setup
After all anastomoses and repairs are confirmed patent and haemostasis is achieved, the wound is closed in layers. A Doppler probe (implantable or surface) is placed over the anastomosis for post-operative monitoring. Dressings are applied without compression. The replanted digit or flap is kept warm and well-perfused.
Step 6 - Post-Operative Monitoring and Rehabilitation
Hourly clinical monitoring of the replanted part or free flap (colour, temperature, capillary refill, Doppler signal) is performed for the first 72 hours. Any deterioration in the vascular signals triggers immediate return to theatre for re-exploration. After the monitoring period, physiotherapy commences for replantation and nerve repair cases to prevent stiffness. Occupational therapy for hand function rehabilitation begins as soon as healing allows. Nerve recovery after repair or grafting takes months to years, and patients are followed up at regular intervals with nerve conduction studies to monitor progress.
Patient Questions About Microsurgery
Can a completely severed finger or hand be reattached?
Yes - replantation of completely severed digits and hands is possible with microsurgery if the amputated part and the patient meet the criteria for replantation. The best candidates are clean amputations (guillotine mechanism rather than crush or avulsion), thumb amputations (the thumb is the most functionally important digit), multiple digit amputations, hand and wrist level amputations, and amputations in children. The amputated part should be kept moist and cool (wrapped in moist gauze, placed in a sealed bag, and kept on ice - not in direct contact with ice) and the patient should reach a microsurgery centre as soon as possible. Survival of the replanted part is over 80% in experienced hands for clean digital amputations.
How long does recovery take after digit replantation?
Recovery after digit replantation is a prolonged process. The replanted digit achieves vascular stability within the first 72 hours. Sensation begins to return as early as 3 to 6 months (depending on the level of amputation) as the repaired nerves regenerate at approximately 1mm per day. Full motor recovery and range of motion take 6 to 12 months of physiotherapy. The replanted digit will never function exactly like an uninjured digit - some stiffness, cold intolerance, and reduced sensory discrimination are common - but a successful replantation provides far superior function to a prosthetic replacement, particularly for the thumb and for children whose plasticity allows excellent functional recovery.
Does microsurgery for lymphoedema cure the condition?
LVA surgery does not cure lymphoedema but can significantly reduce limb swelling, reduce the frequency of lymphangitis (skin infections), and improve quality of life. In early-stage lymphoedema with functioning lymphatics confirmed by ICG lymphography, LVA can reduce limb volume by 30 to 70% and many patients are able to reduce or eliminate the need for compression garments over time. Results are best in patients with early-stage lymphoedema before significant tissue fibrosis has developed. LVA is combined with ongoing complete decongestive therapy (CDT) including manual lymphatic drainage and compression garment use for optimal long-term results. Regular follow-up with volume measurements and repeat lymphography monitors progress.
What is the difference between nerve repair and nerve grafting?
Primary nerve repair (direct suture) is performed when the nerve ends can be brought together under no tension after trimming back to healthy fascicles. This is typically possible when the nerve gap is less than 1 to 2cm. Nerve grafting is required when the nerve gap is too large for direct repair without tension - using a graft (usually the sural nerve harvested from the back of the calf) to bridge the gap. The sural nerve is expendable (its removal causes only a small patch of numbness on the outer foot) and provides an excellent conduit for nerve regeneration across large gaps. Nerve conduits (synthetic or biological tubes) are an alternative to nerve grafts for small gaps up to 3cm. Both techniques are performed under the operating microscope with 9-0 nylon sutures.
Evidence-Based Case Studies by Our Specialists
Would Recommend Us
"I lost three fingers in a factory accident. The team at Shree Hospitals operated immediately and reattached all three. It took months of physiotherapy but I have my fingers back and I am working again. I cannot thank the microsurgery team enough."
Mr. Ramesh K.
"After my throat cancer surgery I was told I would need a tube in my stomach for feeding. The microsurgery team reconstructed my food passage using tissue from my bowel. Within weeks I was eating again. It is a miracle what surgery can do."
Mr. Ganesh P.
"My arm was so swollen after my cancer treatment that I could not wear my clothes or work comfortably. After the LVA surgery at Shree Hospitals the swelling came down dramatically over several months. I no longer need to wear the pressure sleeve every day."
Mrs. Seema T.
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