Microsurgery: A 10-Year Experience with Loupe Magnification

Abstract

Background Microsurgical procedures are still rare in many countries especially in resource-constrained countries. Among reasons for this is the unavailability of operating microscopes that are costly. Operating loupes are considered inferior to the microscope and are most discouraged for many microsurgical procedures. We audit patients operated under loupes for the past 10 years and present our findings. Patients and Methods This was a prospective audit of patients who underwent microsurgical reconstructive procedures in the plastic surgery unit at Kenyatta National Hospital between January 2009 and December 2019. Results A total of 352 patients with 360 procedures were done over a 10-year period. The age range for the patients was 5 to 90 years. Free flaps accounted for 78% of the surgical procedures (n = 298) followed by nerve repairs 8.8% (n = 32) and reimplantation surgeries 8.5% (n = 30). The overall success rate for free flaps was 93.3% with reimplantations of 77%. Conclusion Microsurgical reconstructive procedures as demonstrated in this study can safely be done with loupes. Loupes provide an alternative means of magnification that is cost effective and cheaper. In good hands, good surgical outcomes can be achieved that are comparable to the operating microscopes.

Microvascular surgery using surgical loupes versus operating microscope—A single head and neck reconstructive surgeon's experience

“…Serletti et al studied over 200 patients undergoing free tissue transfer surgery for breast, H&N, and extremity defect repair. 8 Their study found no difference in free flap failure rate and surgical outcomes between surgical loupes and the operating microscope. They importantly mention that their success using surgical loupes was attributable to their prior training with the operating microscope.…”

Clinical application and outcomes of reconstructive microsurgery in Africa: A systematic review and meta-analysis

“…[47][48][49] However, the primary reason for their wide-spread use in LMIC is the low cost and low maintenance required. [50][51][52] In contrast, visiting surgeons from HIC and those in well-established tertiary centers in Egypt showed significantly higher preference for the microscope. We found no statistically significant difference in free flap success and complication rates between the two magnification methods in agreement with several previous studies that have also shown equivalent outcomes.…”

“…However, shortages of trained support staff including nurses and anesthetists in LMIC impede early detection of flap compromise, and even after compromise is detected, further delays in the assembly of the operating team adversely impact the overall results of salvage procedures. 13,51,73 Unfortunately, inadequate reporting of factors relating to flap failure and complications prevented detailed analysis in this study. Nevertheless, the binary logistic regression result showing no association between the different free flaps, each with their own technical perils and free flap success suggests more systematic causes for flap failure that warrant further study.…”

Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa

“…The availability of surgical equipment including microscopes is also a challenge although not well characterized [6 ▪ ,21]. Nangole et al noted this challenge in their 10-year experience with free flaps in Kenya.…”

“…Nangole et al noted this challenge in their 10-year experience with free flaps in Kenya. They performed free flaps with surgical loupes and a basic microvascular set with flap success rates of 93.3% [21]. An ongoing provider survey by the Global OHNS initiative may provide a better understanding of the infrastructure available for head and neck reconstruction, and this may better assist in planning and advocacy [22].…”