Use of the operating microscope and loupes for head and neck free microvascular tissue transfer: a retrospective comparison.

OBJECTIVE To analyze whether less cumbersome loupes are as equally efficacious as the microscope for magnification for free tissue transfers in head and neck reconstruction. DESIGN A 7-year retrospective review of 151 consecutive microvascular free tissue transfers compares the operating microscope with loupe magnification. SETTING A tertiary care medical center. PATIENTS A total of 151 consecutive patients undergoing microvascular reconstructions. INTERVENTION Microvascular reconstruction of ablative head and neck cancer defects using either microscopic or loupe-provided magnification. MAIN OUTCOME MEASURES Medical records were reviewed for demographic data, preoperative radiation status, type of defect and flap, length of procedure, complications, and length of stay. RESULTS Two teams shared the reconstructions, with all microvascular anastomoses created or directly supervised by one of us (D.A.R.). One team used the operating microscope for magnification (84 cases), while the other used loupes (67 cases). Complication rates were statistically similar for the 2 techniques, the length of procedure tended to be shorter in the loupe group, and the length of stay was statistically similar in both groups. CONCLUSIONS A review of the literature validates the usefulness of loupe magnification in free tissue transfer surgery. To our knowledge, this is the largest number of head and neck reconstruction cases presented comparing these techniques. Loupes offer the surgeon comfort and easy access to and uncomplicated visualization of the operating field. Furthermore, loupes may decrease operating time and help avoid complicated equipment. Therefore, loupe magnification should be considered in head and neck reconstruction without the fear of increased morbidity.