Loupes vs microscopes in microsurgical reconstructions: A retrospective review of patient records from 2 large tertiary hospitals in Lagos, Nigeria

Abstract

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Background: Microvascular reconstruction is increasingly performed in many developing countries. Recently, some surgeons have begun to exclusively use loupes due to their perceived ease of use to aid visualization in microsurgery. This study compared loupe-based vs operating microscope–based microsurgical reconstruction in a resource-constrained setting.

Methods: A retrospective chart review was conducted at 2 tertiary centres in Lagos, Nigeria, offering reconstructive microsurgery—1 using loupes and the other using microscopes. Data on demographics, flap type, defect site, reconstruction indication, surgery duration, flap survival rates, and hospital stay duration were recorded.

Results: Over a 5-year period, 61 microsurgical reconstructions were performed. The mean patient age was 43.5±4.6 years, with trauma as the underlying pathogenetic mechanism in 62.9% of cases, while oncologic resections accounted for the remainder. The anterolateral thigh (42.6%) and rectus femoris flaps (31.1%) were the most commonly transferred. No significant differences were observed between the loupes and microscope groups in terms of take-back rates, flap loss rates, or hospitalization duration. The overall flap loss rate was 12%. A significantly shorter mean operative time was noted in the loupe group (P<0.001).

Conclusions: This study highlighted the challenges of reexploring failing flaps in low-resource settings. Loupe microsurgery may offer a cost-effective and quicker alternative for many microsurgical reconstructions when a microscope is unavailable.