"Matched Comparison of Microsurgical Anastomoses Performed with Loupes Magnification Versus Operating Microscope in Traumatic Lower Extremity Reconstruction".

Abstract

BACKGROUND While the surgical microscope remains the most common method for visual magnification for microsurgical anastomoses in free tissue transfer, loupes-only magnification for free flap breast reconstruction has been demonstrated to be safe and effective. In order to evaluate the loupes-only technique in lower extremity free flap reconstruction, we compared perioperative outcomes between microsurgical anastomoses performed with loupes magnification versus a surgical microscope. METHODS Two-institution retrospective study of soft tissue free flaps for traumatic below-knee reconstruction. Optimal subgroup matching was performed using patient age, defect location, flap type (muscle vs. fasciocutaneous), and time from injury (acute <30 days vs. remote >30 days) for conditional logistic regression analysis of perioperative outcomes. RESULTS 373 flaps met inclusion criteria for direct matched comparison of anastomoses performed with loupes magnification (n=150) versus a surgical microscope (n=223). Overall major complication rates were 15.3%: takeback for vascular compromise 7.8%, partial flap failure 7.8%, and total flap loss 5.4%. No differences were observed between the loupes and microscope groups in regards to major complications (14.0% vs. 16.1%;OR=0.78(0.38-1.59)), takeback for vascular compromise (5.3% vs. 9.4%;OR=0.51(0.19-1.39)), any flap failure (13.3% vs. 13.0%;OR=1.21(0.56-2.64)), partial flap failure (7.3% vs. 8.1%;OR=1.04(0.43-2.54)), and total flap loss (6.0% vs. 4.9%;OR=1.63(0.42-6.35)). CONCLUSIONS Perioperative complication rates, takebacks for vascular compromise, partial flap losses, and total flap failure rates were not significantly different between the matched loupes and microscope groups. Overall microsurgical success rates in traumatic lower extremity free flap reconstruction appear to be independent of the microsurgical technique used for visual magnification.