COMPARISON OF THE OPERATING MICROSCOPE AND LOUPES FOR FREE MICROVASCULAR TISSUE TRANSFER

A retrospective study of 200 consecutive free microvascular tissue tra nsfers over a 3-year period was done to compare the performance of fre e-tissue transfers with loupes and with the operating microscope. One- hundred and nineteen flaps (59.5 percent) were performed under 3.5x lo upe magnification and 81 under the operating microscope (40.5 percent) . The magnification selection process was based on cumulative past exp erience, with all early anastomoses performed with the microscope and the vast majority of the more recent operations performed with loupe m agnification. Loupes were used preferentially for head and neck recons truction and breast reconstruction. The microscope was required for pe rforming vascular anastomoses on children and on vessels less than or equal to 1.5 mm in diameter. Results were compared with respect to eti ology of defect, type of flap, age of patient, free-flap success, comp lications, and overall success of the reconstruction. There was no dif ference in outcome between the two groups, with free-flap success rate s of 99 percent for both the loupe and the microscope groups. We belie ve that our success with loupe-only free-tissue transfers is attributa ble to our prior considerable experience with the microscope. We would caution that comfort and experience with microanastomoses under the o perating microscope should be obtained prior to beginning loupe-only e xperience.