Sm. Shenaq et al., FREE-TISSUE TRANSFER WITH THE AID OF LOUPE MAGNIFICATION - EXPERIENCEWITH 251 PROCEDURES, Plastic and reconstructive surgery, 95(2), 1995, pp. 261-269
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.