Evaluation of free flap surgery with loupe magnification

Mahammad Asfak Ahmed, Pruthwiraj Singh, Bibhuti Bhusan Nayak

Abstract


Background: The role of magnification is paramount in free flap surgery as magnification gives a clear, well-defined, sharp definition to the blood vessels and successful anastomosis of small caliber blood vessels becomes a reality. In the literature, studies have reported that the success rate of free flap surgery under microscope magnification is around 89% to 99% and similar success rate have been achieved with loupe magnification as well in suitable flaps.
Objective: In this study our objective was to determine the feasibility and safety of micro-vascular free flap surgery under 4x loupe magnification, in suitable flaps. 
Materials and Methods: This study was a prospective observational case series of 50 adult patients admitted for reconstruction of defects of different etiology at different sites of the body for functional restoration and contour correction from September 2016 to October 2018. The study was conducted in the department of plastic surgery, SCB medical college, Cuttack, Odisha, India. Outcome variables included vascular complications of flaps, re-exploration of flaps, salvage of flap and flap failure. Chi square analysis was performed to find out the significance of association of flap failure at different sites.
Results: Total 50 cases of consecutive free tissue transfer were carried out under x4 loupe magnification in different sites of the body and the re-exploration rate was 10 (20%), the flap salvage rate was 5 (50%) out of 10 cases and revision anastomosis rate was 8 (16%) and success rate was 45 (90%).
Conclusion: We observed that micro-vascular free flap surgery is feasible and safe under optical loupe-4x magnification to reconstruct defects at selected sites of the body with suitable flaps with pedicle and recipient vessel diameter 1.5mm or more in size.

Keywords: Free flaps, Free tissue transfer, Microvascular surgery.


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