FREE-TISSUE TRANSFER WITH THE AID OF LOUPE MAGNIFICATION - EXPERIENCEWITH 251 PROCEDURES

Eight years ago, the principal author (Shenaq) began employing high-po wer ocular loupes for microvascular anastomoses. Subsequently, 251 fre e-tissue transfers were performed with loupes as the sole means of mag nification. Procedures included free flaps, toe-to-hand transfers, and digital replantations, with the external diameter of the vascular ped icles averaging 1.5 mm. Analysis of the series revealed a 97.2 percent overall success rate, a 1.2 percent partial flap necrosis rate, and a n 8.3 percent revision rate for anastomoses (during the initial operat ive procedure), which compare favorably with the success rates frequen tly cited for microscope-assisted procedures. The most favorable resul ts were achieved with free flaps and toe-to-hand transfers with 98.5 a nd 96.4 percent success rates, respectively. The 79.2 percent survival rate achieved with digital replantation falls within the range (14.0 to 94.2 percent) reported in the literature. This experience indicates that in practiced hands, high-power ocular loupes provide an alternat ive to the operating microscope for microvascular anastomosis of vesse ls 1.0 mm or greater in diameter. Loupe use is advocated on the ground s of cost-effectiveness, portability, and operator freedom.