Preface

[[AUTHOR PHOTO]] [[AUTHOR PHOTO]]Microvascular surgery, almost a century old, is in its "golden age" of practice. The number of reconstructive microsurgical cases documented in the National Clearinghouse of Plastic Surgery Statistics for 2001 was 24, 346, up 26% from 1992 and 9% since 2000. This significant change is in the face of an overall increase in reconstructive plastic surgery of 31% since 1992.

Clearly, the microsurgical approach to reconstructive surgery is alive and well and is here to stay. Because of the tremendous value added to the care of many patients, it will remain an essential part of plastic surgery and find application in nearly every other surgical specialty. Today we are witnessing an evolution in microsurgery both technically and practically. There continues to be refinement in flap design and application that minimizes donor site morbidity while advancing aesthetic and functional outcomes. The frontiers of reconstructive microsurgery have moved away from technical issues to practical ones related to teaching and promoting routine practice in an environment of contracting health care resources.

This issue contains a collection of informative and thought-provoking articles concerning the past, present, and future of reconstructive microsurgery. Harry Bunke, one of the fathers of clinical microsurgery, and co-author David Chang recount the historical development in a fascinating and inspirational way. Next, there is a series of articles addressing current topics relating to training, techniques, and practice maintenance. The final set of articles addresses the future with a focus on tissue engineering with special consideration of bone, adipose, and skin tissues.

At the opening of the 20th century, the most visionary surgeons could not have imagined the advances in surgical anatomy, patient care, and technology that have led to modern reconstructive microsurgery. What now lies ahead is equally difficult to predict. Technical advances will ultimately lead to reconstructive procedures using custom-engineered tissues incorporated into the patient's normal tissues by novel methods of revascularization related to microsurgery, but will the realities of an aging population and increasing strain on health care resources limit the development and availability of these new techniques? In many ways, how this question is answered is in our hands. To this end, more and more of our young plastic surgeons are coming to the realization of the absolute importance of honing expert microsurgical skills to accommodate the ever-evolving complexity of head and neck, torso, and extremity deformities to rehabilitate the patient to a satisfactory outcome.