NAKED EYE FREE TISSUE TRANSFERS

Over the past ten years, neither the operating microscope nor magnifyi ng glasses have been used routinely for elective microsurgery. The wha le operation is performed with the naked eye, vascular anastomoses inc luded. From January of 1992 to December of 1993, 37 free tissue transf ers have been performed on 36 patients. An operating microscope was us ed in only 6 cases (5 free flaps, and 1 emergency exploration for thro mbosis). In the other 37 cases (33 free flaps, and 5 emergency explora tions for thrombosis), the anastomoses were performed with the naked e ye. In a total number of 103 vascular anastomoses, the microscope was used in 14 cases, and the naked eye in 89 cases. The only failure of o ur series was performed in the classical way, in addition to the emerg ency exploration and its salvage by a second free flap. There were no failures in the naked eye cases. In the 5 other cases, emergency explo ration allowed salvage of the flap. No technical error in the vascular anastomoses occurred in any of those cases. The authors conclude that elective free-tissue transfer in plastic surgery is routinely possibl e, safe and reliable, without the microscope or magnifying glasses, pr ovided that vessels of the flap and recipient vessels be chosen with s ufficient diameter. In practice, this situation was encountered in mor e than 85 percent of the cases.