10.04.2025

Advancements in microsurgery at Privatklinik Bethanien

Microsurgery has transformed the landscape of reconstructive medicine, combining precision, innovation, and artistry to restore form and function in even the most complex cases. With the advent of supermicrosurgery, surgeons are now able to manage vessels smaller than 0.8 mm, unlocking possibilities once deemed unachievable. From intricate reconstructions following trauma and cancer to the physiological restoration of lymphatic flow in lymphedema, micro and supermicro-surgical techniques empower surgeons to redefine the possibilities of patient care.

Latest Innovations

The superficial circumflex iliac artery perforator (SCIP) flap for Head and Neck Reconstruction

The superficial circumflex iliac artery perforator (SCIP) flap represents an extremely reliable and versatile option for head and neck reconstructions. Over the years, we collected a large base of experience, including both simple and chimeric SCIP-based reconstruction, making this flap our first choice for head and neck reconstructions. The flap’s ability to provide thin and pliable tissue make it ideal for facial and intraoral defects, ensuring high patient satisfaction and reconstructive outcomes.

Female patient affected by left tongue squamous cell carcinoma (SCC) who underwent hemiglossectomy combined with neck dissection. The tongue was reconstructed with a free SCIP flap from the left groin.

Images from: Scaglioni, M. F., Meroni, M., Meschino, A., & Rajan, G. P. (2024). The Superficial Circumflex Iliac Artery Perforator Flap for Head and Neck Reconstruction. Oral and maxillofacial surgery clinics of North America, 36(4), 489–495.

Sensitive images of the operation process (blood, details) are password-protected; use the password reconstruction to view them.

Minimally Invasive Breast Reconstruction

Microsurgery has revolutionized breast reconstruction through employment of perforators flap, allowing natural and long stable reconstruction, helping patients to regain confidence in their bodies. Over the years, interest in reducing the morbidity at donor and recipient site has grown. Advancement in technologies and surgical techniques have now making possible to achieve minimally invasive breast reconstruction.

Perforator-to-perforator anastomosis

The perforator-to-perforator anastomosis minimizes donor site morbidity by directly connecting the perforator flap vessels with the internal mammary perforators, bypassing the need to dissect and employ the internal mammary artery. This innovation not only preserves native anatomy but also reduces postoperative pain and accelerates recovery. In cases where there are not suitable perforators, the rib sparing internal mammary vessel dissection could be another way to minimize the donor site morbidity.

Images of preparation of internal mammary perforator. (a) Low power view showing the exposed internal mammary perforator vessels as they emerge lateral to the sternum. (b) Exposure of the internal mammary perforator vessels during a skin-sparing mastectomy. (c) Subcutaneous dissection and exposure of the Internal mammary perforator vessels during a skin-sparing mastectomy. (d) Internal mammary perforator vessels, as they emerge from the second intercostal space to penetrate the pectoralis major muscle and it's deep fascia, before entering the subcutaneous tissue. (e and f) Microscope view of internal mammary perforator vessels following preparation and ready for the anastomoses.

Images from: Vourvachis, M., Goodarzi, M. R., Scaglioni, M. F., Tartanus, J., Jones, A., Cheng, H. T., &Abdelrahman, M. (2024). Utilization of the internal mammary perforators as the recipient vessels for microsurgical breast reconstruction: A systematic review and meta-analysis of the literature. Microsurgery, 44(1), e31105.

Sensitive images of the operation process (blood, details) are password-protected; use the password reconstruction to view them.

Robotic assisted flap harvest

Robotic-assisted techniques allow precise dissection of perforator vessels, reducing invasiveness and enhancing recovery.

The superficial circumflex iliac artery perforator (SCIP) flap for breast reconstruction

The use of SCIP flaps in breast reconstruction represents a minimally invasive solution. The major advantage is that it avoids opening the rectus fascia or performing intramuscular dissection, making it considerably less invasive.

Innovations in Lymphatic Surgery

Lymphatic surgery has seen remarkable advancements, addressing conditions with physiological approaches that restore lymphatic flow.

Lymphaticovenous Anastomosis (LVA)

It represents a cornerstone of lymphedema treatment. LVA connects functional lymphatic vessels directly to the venous system, bypassing obstructed pathways. This minimally invasive technique is particularly effective in early-stage lymphedema, offering immediate symptom relief.

Intraoperative picture of LVA performed in end-to-side fashion. Vessels isolated and prepared for the anastomosis (A,B); lymphatic vessel anastomosed to the side of the nearby larger-caliber vein (C); immediate intraoperative ICG lymphography proving the patency of the anastomosis (D); 12-month postoperative ICG lymphography showing conserved patency (E).

Images from: Scaglioni, M. F., Meroni, M., & Fritsche, E. (2020). Lymphaticovenous anastomosis (LVA) for breast cancer-related lymphedema treatment.

Sensitive images of the operation process (blood, details) are password-protected; use the password reconstruction to view them.

Translational cancer research, Vascularized Lymph Node Transfer (VLNT)

VLNT involves the transfer of healthy lymph nodes with their vascular supply to affected areas. The selective harvesting of the node that drain the abdomen or from intra-abdominal sites, minimize the risk of secondary donor site lymphedema.

9(5), 3167–3171.

Figure left: Mapping arteries and lymphatic vessels demonstrated on radiographs in two specimens. Purple indicates efferent lymphatic vessels of the leg sentinel nodes (AeC); blue, deep lymphatic vessels; green, superficial lymphatic vessels; and red, arteries. The “*” indicates the superficial circumflex iliac artery; “**” indicates the superficial inferior epigastric artery. The black arrowheads indicate directions of lymph flow.

Figure right: Lymphosomes in the inguinal region: the abdominal (orange), lateral thigh (green), and medial thigh (yellow) groups are shown.

Images from: Scaglioni, M. F., & Suami, H. (2015). Lymphatic anatomy of the inguinal region in aid of vascularized lymph node flap harvesting. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 68(3), 419–427.

Vascularized Lymphatic Vessel Transfer (VLVT)

A promising innovation, VLVT transfers functional lymphatic vessels as a free flap, enabling immediate lymphatic flow restoration and treatment of advanced stages lymphedema.

Pedicled Circumflex Scapular Artery (pCSA) Perforator Flap for arm lymphedema

The pedicled circumflex scapular artery perforator flap represents a versatile technique in upper body reconstruction. The lymphatic rich area from where the flap is harvested enable its transfer in the axilla for the treatment of complications related to axillary lymphadenectomy.

Patient affected by lymphedema of the right arm, secondary to breast cancer treatment. She presented a significant axilla scar retraction at the right axilla. She was treated with transfer of lymphatic tissue based on lymphatic pCSA perforator flap and LVA at the right arm.

Images from: Meroni, M., & Scaglioni, M. F. (2024). Revisiting the pedicled circumflex scapular artery (pCSA) perforator flap: From simple to complex locoregional reconstructions. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 90, 336–345.

Sensitive images of the operation process (blood, details) are password-protected; use the password reconstruction to view them.

Privatklinik Bethanien

Prof. Dr. med. Mario Scaglioni

Specialisation
Plastic surgery, Hand surgery, Lymphology, Super microsurgery,

Book an appointment

References

Scaglioni, M. F., Meroni, M., Tomasetti, P. E., & Rajan, G. P. (2024). Head and neck reconstruction with the superficial circumflex iliac artery perforator (SCIP) free flap: Lessons learned after 73 cases. Head & neck, 46 (6), 8–1438.
Scaglioni, M. F., Meroni, M., Meschino, A., & Rajan, G. P. (2024). The Superficial Circumflex Iliac Artery Perforator Flap for Head and Neck Reconstruction. Oral and maxillofacial surgery clinics of North America, 36(4), 489–495.
Vourvachis, M., Goodarzi, M. R., Scaglioni, M. F., Tartanus, J., Jones, A., Cheng, H. T., &Abdelrahman, M. (2024). Utilization of the internal mammary perforators as the recipient vessels for microsurgical breast reconstruction: A systematic review and meta-analysis of the literature. Microsurgery, 44(1), e31105.
Scaglioni, M. F., Fontein, D. B. Y., Arvanitakis, M., & Giovanoli, P. (2017). Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery, 37(8), 947–953.
Scaglioni, M. F., Meroni, M., & Fritsche, E. (2020). Lymphaticovenous anastomosis (LVA) for breast cancer-related lymphedema treatment. Translational cancer research, 9(5), 3167–3171.
Scaglioni, M. F., & Suami, H. (2015). Lymphatic anatomy of the inguinal region in aid of vascularized lymph node flap harvesting. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 68(3), 419–427.
Scaglioni, M. F., Arvanitakis, M., Chen, Y. C., Giovanoli, P., Chia-Shen Yang, J., & Chang, E. I. (2018). Comprehensive review of vascularized lymph node transfers for lymphedema: Outcomes and complications. Microsurgery, 38(2), 222–229.
Meroni, M., & Scaglioni, M. F. (2024). Revisiting the pedicled circumflex scapular artery (pCSA) perforator flap: From simple to complex locoregional reconstructions. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 90, 336–345.

Hospitals

Centres

For patients

About us

Hospitals

Centres

For patients

About us

How can we help you?

Top searches

Advancements in microsurgery at Privatklinik Bethanien

Latest Innovations

The superficial circumflex iliac artery perforator (SCIP) flap for Head and Neck Reconstruction

Minimally Invasive Breast Reconstruction

Perforator-to-perforator anastomosis

Robotic assisted flap harvest

The superficial circumflex iliac artery perforator (SCIP) flap for breast reconstruction

Innovations in Lymphatic Surgery

Lymphaticovenous Anastomosis (LVA)

Translational cancer research, Vascularized Lymph Node Transfer (VLNT)

Vascularized Lymphatic Vessel Transfer (VLVT)

Prof. Dr. med. Mario Scaglioni