Microsurgery
who are at various stages of treatment and are run by the plastic surgery Breast Reconstruction Nurses. Emily continues: “I met very helpful ladies who had had their surgery two years earlier, so I was able to learn from their experiences. One lady suggested that I should ask for Immediate Lymphatic Reconstruction as it would help reduce the chances of lymphoedema in the future. My mother-in law was also invaluable at this point as she had been a nurse and had experience of dealing with people after breast cancer. “When I got to the hospital pre-operation, I
was delighted when Mr. Johal told me that he was already doing ILR and explained that it was preventive surgery.” Emily went on to have a mastectomy, axillary lymph node removal, breast reconstruction with a DIEP flap (from the tummy) and ILR in one operation under the care of Mr Johal. Emily concludes: “I feel so grateful that I
was able to benefit from ILR. Lymphoedema is hard to treat and as I was younger when I was diagnosed, I might have had to live with it for the rest of my life if the surgery hadn’t taken place. It’s important that people are aware of this technique and are able to find out as much information about it before reconstruction. “Having breast cancer at such a young
age was a huge shock, but we just had to get through it as a family. After my diagnosis, one of the hardest things for us was trying to explain to our children what was happening to us in a way that they would understand and relate to, so I decided to write a book, ‘Mummy’s Journey’ which is out soon.
“Dealing with the immediacy of cancer
is tough in itself, but I can’t stress enough how important it is to be aware of possible complications afterwards. To share my experiences and help other people, I set up a feed on Instagram @thebravemumclub to spread awareness and share my own experiences which, in course, has led to a website
www.thebravemumclub.co.uk which is, hopefully, a useful resource for those who are now in the position I was.”
COMMENT with DANIEL COOLE
Microsurgery and instrument care
Daniel Coole, Chair of the ABHI Surgical Instruments Group and managing director at Surgical Holdings, issues a reminder that microsurgery instruments require special care and maintenance to ensure performance and patient safety. Microsurgery is one of the most technically challenging areas of modern surgery. It
CSJ
References 1.
https://www.thebls.com/pages/what-is- lymphoedema#:~:text=There%20are%20 estimated%20to%20be,Disease%2C%20HIV%20 and%20Parkinson›s%20Disease.
2.
https://www.bbc.com/future/article/20241216- lymphoedema-the-hidden-pandemic-affecting- 250-million
3.
https://www.thebls.com/pages/what-is- lymphoedema
4.
https://acsjournals.onlinelibrary.wiley.com/ doi/10.1002/cncr.34489
54
www.clinicalservicesjournal.com I July 2026
involves operating on very small anatomical structures, often under a microscope or high- powered magnification, using instruments designed for delicate tissue, vessels and nerves. Its purpose is to restore function, blood supply or anatomical continuity where conventional techniques would be too coarse. For patients, benefits include improved restoration of form and function which otherwise could not be achieved, better wound coverage, preservation of limbs or digits, improved sensation or movement after nerve repair and reconstruction using the patient’s own tissue where appropriate. Typical procedures include small-vessel repair, nerve repair, free tissue transfer, lymphaticovenous anastomosis, perforator flap surgery and digit replantation. In reconstructive surgery, microsurgery allows tissue to be moved from one part of the body to another, with tiny arteries and veins reconnected to restore circulation. This is common in breast reconstruction, head and neck reconstruction, lower limb trauma, complex wound coverage and post-oncological reconstruction. Microsurgical instruments are lighter, finer and more delicate than standard surgical instruments. They are commonly manufactured from stainless steel or titanium, with titanium offering reduced weight. Key distinctions include balance, tip alignment, closing pressure and tactile feedback, all of which influence surgical control. Common examples include micro forceps, micro needle holders, micro scissors, vessel dilators, vascular clamps, approximator clamps, micro retractors and bipolar forceps. Micro forceps hold delicate tissue, nerves, sutures or vessel walls with minimal trauma. Micro needle holders control fine needles and sutures, while micro scissors support precise dissection and vessel preparation. Vessel dilators open the lumen of small vessels, and microvascular clamps temporarily control blood flow without crushing the vessel wall. Instrument technology has also advanced from standard microsurgical tools to ultra- fine instruments for super microsurgery. In practical terms, 0.3 mm tips are commonly suited to standard microvascular work, 0.2 mm tips support more delicate vessel or nerve handling, and specialist 0.1 mm tips are used for highly demanding work on very small vessels, lymphatics or delicate tissue structures. These instruments are often manufactured and hand-finished under magnification, with Swiss manufacturers widely recognised for expertise in this field. Instrument choice depends on the procedure. In free flap surgery, micro clamps, dilators, forceps, scissors, and needle holders are used at donor and recipient sites to prepare arteries and veins for anastomosis. When a microvascular coupler is used for venous anastomosis, precision instruments remain essential for vessel selection, trimming, dilation, eversion, and placement of the vessel ends onto the coupler rings. In peripheral nerve repair, fine forceps and needle holders align nerve ends and place
delicate sutures with minimal handling. In lymphatic surgery, ultra-fine instruments support preparation and anastomosis of small lymphatic channels and venules. Because microsurgical instruments are so fine, maintenance is central to performance and patient safety. Even minor tip damage, misalignment, staining or stiffness can affect handling, particularly during small-vessel preparation or use with a microvascular coupler. These instruments should be treated as precision devices rather than general theatre tools, with delicate tips protected throughout handling, reprocessing, and sterilisation. Planned preventative maintenance is an important aspect of ensuring patient safety and
must not be overlooked – this should include inspection, functional testing, refurbishment, sharpening, realignment and replacement, when instruments no longer meet performance standards.
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