Supermicrosurgery in Reconstructive Surgery: A Narrative Review

Supermicrosurgery, defined as the anastomosis of vessels smaller than 0.8 mm, represents a significant evolution in the field of reconstructive microsurgery. This review explores its technical foundations, clinical applications, and future directions, with a particular focus on lower extremity reconstruction. By utilizing perforator-to-perforator anastomosis and thin flap techniques, supermicrosurgery allows for reduced donor morbidity, minimized risk to major vessels, and improved aesthetic and functional outcomes. The integration of high-frequency ultrasonography and advanced microsurgical tools has enhanced preoperative planning and intraoperative precision. Despite a steep learning curve, supermicrosurgery is increasingly applied in oncologic, traumatic, ischemic, and diabetic foot reconstructions. Continued innovation in imaging, instrumentation, and robotic assistance suggests a promising future for this subspecialty.