Naked eye free tissue transfers

Abstract

Over the past ten years, neither the operating microscope nor magnifying glasses have been used routinely for elective microsurgery. The whole operation is performed with the naked eye, vascular anastomoses included. From January of 1992 to December of 1993, 37 free tissue transfers have been performed on 36 patients. An operating microscope was used in only 6 cases (5 free flaps, and 1 emergency exploration for thrombosis). In the other 37 cases (33 free flaps, and 5 emergency explorations for thrombosis), the anastomoses were performed with the naked eye. In a total number of 103 vascular anastomoses, the microscope was used in 14 cases, and the naked eye in 89 cases. The only failure of our series was performed in the classical way, in addition to the emergency exploration and its salvage by a second free flap. There were no failures in the naked eye cases. In the 5 other cases, emergency exploration allowed salvage of the flap. No technical error in the vascular anastomoses occurred in any of those cases.

The authors conclude that elective free-tissue transfer in plastic surgery is routinely possible, safe and reliable, without the microscope or magnifying glasses, provided that vessels of the flap and recipient vessels be chosen with sufficient diameter. In practice, this situation was encountered in more than 85 percent of the cases.