CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2020; 05(02): e90-e94
DOI: 10.1055/s-0040-1718517
Original Article

Microsurgery: A 10-Year Experience with Loupe Magnification

Ferdinand Wanjala Nangole
1   Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
,
Stanley Ominde Khainga
1   Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
› Author Affiliations

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.



Publication History

Received: 20 May 2020

Accepted: 25 August 2020

Article published online:
14 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Tang JB, Saint-Cyr M. Microsurgery half a century after establishment: global perspectives. Clin Plast Surg 2017; 44 (02) xiii-xiv
  • 2 Nangole WF, Khainga S, Aswani J, Kahoro L, Vilembwa A. Free flaps in a resource constrained environment: a five-year experience—outcomes and lessons learned. Plast Surg Int 2015; 2015: 194174
  • 3 Banda CH, Georgios P, Narushima M, Ishiura R, Fujita M, Goran J. Challenges in global reconstructive microsurgery: the sub-Saharan African surgeons' perspective. JPRAS Open 2019; 20: 19-26
  • 4 Lim YS, Kim JS, Kim NG, Lee KS, Choi JH, Park SW. Free flap reconstruction of head and neck defects after oncologic ablation: one surgeon's outcomes in 42 cases. Arch Plast Surg 2014; 41 (02) 148-152
  • 5 Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y. Free-flap reconstruction of the tongue. Semin Plast Surg 2019; 33 (01) 38-45
  • 6 Pu LLQ. A comprehensive approach to lower extremity free-tissue transfer. Plast Reconstr Surg Glob Open 2017; 5 (02) e1228
  • 7 Kang MJ, Chung CH, Chang YJ, Kim KH. Reconstruction of the lower extremity using free flaps. Arch Plast Surg 2013; 40 (05) 575-583
  • 8 Ashworth DR, Whear NM, Fan V. Radial free flaps using loupe magnification: audit of 97 cases of orofacial reconstruction. Br J Oral Maxillofac Surg 2004; 42 (01) 36-37
  • 9 Ehanire T, Singhal D, Mast B, Leyngold M. Safety of microsurgery under loupes versus microscope: a head-to-head comparison of 2 surgeons with similar experiences. Ann Plast Surg 2018; 80 (6S, suppl 6): S340-S342
  • 10 Passos GD, Price CE, Piennar CH. Loupe magnification for head and neck free flap reconstruction in a developing country. Eur J Plast Surg 2015; 87 (02) 217-312
  • 11 Shenaq SM, Klebuc MJ, Vargo D. Free-tissue transfer with the aid of loupe magnification: experience with 251 procedures. Plast Reconstr Surg 1995; 95 (02) 261-269
  • 12 Pannucci CJ, Basta MN, Kovach SJ, Kanchwala SK, Wu LC, Serletti JM. Loupes-only microsurgery is a safe alternative to the operating microscope: an analysis of 1,649 consecutive free flap breast reconstructions. J Reconstr Microsurg 2015; 31 (09) 636-642
  • 13 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. J Hand Microsurg 2017; 9 (02) 92-94
  • 14 Tatebe M, Urata S, Tanaka K, Kurahashi T, Takeda S, Hir H. Survival rate of limb replantation in different age groups. J Orthop Surg (Hong Kong) 2018; (10) 12-29
  • 15 Mathieu L, Levadoux M, Landevoisin ES, McBride TJM, Rigal S. Digital replantation in forward surgical units: a cases study. SICOT J 2018; 4: 9 DOI: 10.1051/sicotj/2018004.
  • 16 Ferdinand NW, Raduma OS. Post thermal sciatic nerve injury successfully repaired with a sural nerve graft: case report. J Surg 2019; 7 (05) 119-122
  • 17 Wamalwa AO, Nangole FW, Khainga SO. Lymph node transplant in Kenya: a case series of 20 patients - plastic surgery. S Afr J Surg 2019; 57 (01) 54-59
  • 18 Cheng M-H, Loh CYY, Lin C-Y. Outcomes of vascularized lymph node transfer and lymphovenous anastomosis for treatment of primary lymphedema. Plast Reconstr Surg Glob Open 2018; 6 (12) e2056