January 2020 #PRSJournalClub Wrap-Up: Loupes vs. Scope in Lower Extremity Trauma

by Michael S. Hu, MD, MPH, MS
Plastic Surgery Resident
University of Pittsburgh

The January 2020 edition of #PRSJournalClub provided an exciting discussion regarding the use of loupe-only magnification in lower extremity free flap reconstruction. The article, entitled “Matched Comparison of Microsurgical Anastomoses Performed with Loupe Magnification versus Operating Microscope in Traumatic Lower Extremity Reconstruction” by John T. Stranix, MD, Said C. Azoury, MD, Z-Hye Lee, MD, Geoffrey Kozak, MD, Natalie Plana, MD, Vishal D. Thanik, MD, Pierre B. Saadeh, MD, Jamie P. Levine, MD, Scott L. Levin, MD, and Stephen J. Kovach, MD, was discussed on the #PRSJournal Facebook page, which allowed the broad Facebook audience to ask questions directly to the authors and interact with the PRS community.

The article can be found for free here.

In this study, Stranix et al. perform a two-institution retrospective study of soft-tissue free flaps for traumatic below-knee reconstruction, comparing perioperative outcomes between matched microsurgical anastomoses performed with loupe magnification versus a surgical microscope. Using this methodology, the authors studied 373 flaps and demonstrated no differences between the loupe (n=150) and microscope (n=223) groups regarding major complications, take-back for vascular compromise, any flap failure, partial flap failure, and total flap loss. The authors conclude that overall microsurgical success rates in traumatic lower extremity free flap reconstruction is independent of the microsurgical technique used for visual magnification.

This article was also discussed by the current Resident Ambassadors to the PRS Editorial Board, Min-Jeong Cho, MD, Casey Kraft, MD, and Ara Salibian, MD, with special guest Alex Wong, MD. Listen to the excellent podcast discussion below:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (January 25-26, 2020), where established plastic surgeons and residents were able to ask questions, and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided below.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!


This January #PRSJournalClub article (as well as other Journal Club selections from January), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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