Surgical loupes in plastic surgery

[Sir Gillies]

Hello everyone,

I was hoping to get some advice regarding loupes selection for an integrated plastic surgery resident. I found old threads in the general surgery and plastic surgery sections but they are either outdated or not relevant. I spoke to many of my fellow residents and attendings to identify the a) best frame and b) ideal magnification. It seems that x3.5 is what everyone has because we use them for micro as well. Most people use the Design for Visions Yeoman frame, but it is so much heavier when compared to the Oakley Surgitel frame. When asked why don't people buy the Oakley type, the reply has been that you look like an idiot with them and that they hurt your ears : )

I would be grateful if any other plastic surgery resident and attending could share their wisdom and recommend
a) frame
b) magnification (bearing in mind that we also do micro with them)
c) do they hurt your ears or nose when wearing them?

Thank you in advance for your help!

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[plastic]

I'm using 3.5x EF on the titanium frame. Lighter than the Yeoman and comfortable with the curved nose pad.

 

[igap]

I went through my entire residency with 2.5x loupes. We used the microscope for all of our micro. Once I entered practice, I continued to use my 2.5x loupes (the traditional DFV 1950s frames) for hand surgery, and the microscope for replants and free flaps.

Should you get 3.5x loupes? Yes if your program does not use a microscope for microsurgery which is what it sounds like. I find that anything more than 2.5x is overkill for hand cases, but the thought of doing micro without a microscope is appealing. I haven't done any micro cases with loupes but I have a friend who trained at U Penn, and apparently Serletti trains all of his residents to do micro without a microscope.

As far as frames, I find the Oakley frames very comfy and recommend them. I have also used Surge-Tel loupes on occasion with the wire frames and they are also great. DFV frames for anything more than 2.5x tend to strain the bridge of my nose, and my ears.

 

[bottombracket]

I have very strong feelings on this matter. I'm a private practice hand and microsurgeon, and I wear my 4.3x Surgical Acuity loupes daily. I haven't worn my 2.5's in 5+ years. I do most of my vessels under the scope if I'm operating with a colleague, as it's generally ergonomically easier for both people involved and I find that I like to do micro under higher magnification even if I don't need it. If I'm doing a revasc/spaghetti wrist on call by myself and the vessels are large, I'll bang them together with 8-0 and my loupes instead of bothering with getting a scope into the room in the middle of the night. I do all nerve repairs with loupes; digital nerves and 9-0 aren't a problem. I dissect all flaps with loupes. Heck, I even close skin without taking them off.

I replied to the 'loupes in vascular surgery thread' with this answer; I suspect I'm getting old as I can't figure out how to link to a post on a different thread. Here is that information, lightly edited.

Buy a pair of Surgical Acuity 3.8x (their class III high) loupes. I'll tell you why:

(disclaimer: I'm a plastic/hand/microsurgeon. I can hear your replies now: "I can see everything I need to see already." "Everyone else wears 2.5's". "You're not even a general surgeon, you hand weenie." etc... Bear with me.)

1. Cost to value ratio. At 2.5x you are wasting $1200. You can buy an optically darn good pair of safety glasses as droliver said or even a pair of 1.5x readers at Walmart that will do 3/4 of what a 2.5x loupe will do. The magnification that you get for a 2.5x loupe is not worth the money. My first pair of loupes as a PGY-2 were DFV Buddy Holly 2.5's, 'cause that's what all my general surgery friends had. They were fine for vascular but inadequate for plastics so I upgraded to Surgical Acuity 4.3's (class IV low in their terminology) and then I realized that...

2. Detail. You can't tell what you are missing at 2.5x. The level of detail that you see at 3.8x (yes, or 4.3 in my case) is a world of difference. Before you go with 2.5s, borrow a pair drilled to your size (demo pair that fits from a rep, friend, coresident), or find a pair of adjustables (Zeiss, Surgitel, etc) and actually try operating for a week with a 3.5 or 3.8 loupe. Please do this. Trust me. Better yet, try it yourself.

3. Field of view. The field of view is not too small. This was my initial concern on wearing a higher power loupe for daily use. I have worn my 4.3's exclusively for the past 5 years; initially, I thought I'd switch back and forth, use the 2.5's for daily work and 4.3's for hand, kids, micro. Nope. For me at least, once I got used to seeing more and better with bigger loupes, I wanted to keep seeing fine detail. The DFV 3.5's and SA 3.8's both have a perfectly fine field of view for everyday work.

3. Weight. 3.5x expanded field DFVs are heavy and can be hard on your nose. They are still great loupes if you can handle the weight. And for the love of goodness, never EVER buy a non-expanded field DFV 3.5 x loupe. They have a very small field of view and light transmission is terrible. My wife (also plastics) made this mistake and returned them immediately.

4. Surgical Acuity's are nice because the frames are titanium (lightweight), but most importantly, each eyepiece's objective can adjust in and out to account for prescription changes/inaccuracy in fitting. Additionally, the field of view is large. Be careful with their titanium 'sport' frame - it's whippy and flexible, and requires precise placement on your head. The original frame with round lenses is much stiffer.

To summarize: Buy at least a 3.5x loupe; the benefit of added optical clarity is huge and it won't compromise your operative field of view. Surgical Acuity makes good loupes that are light and adjustable.

Please, give a pair of higher powered loupes a shot before settling on 2.5x's of any kind.

bb

 

[310prolene]

Any other opinions on magnification or brand? My program covers one pair...

 

[Valadi]

We get $1500 for loupes. I got 2.5x Surgitel Loupes w/ the Oakley frame at the end of my intern year. These are super light weight, durable, and don't hurt your neck. On hand / peds rotations I basically leave them around my neck the entire day. They are also great for clinic / ED for taking out small sutures or doing lac repairs. Probably most importantly, as soon as I use these with patients in the clinic / ED they immediately think some magic has been performed and are visibly more at ease.

That being said, I agree with the poster above that you can get much of their benefit with a pair of reading glasses. I bought a 1.5x and 2x reading glasses from amazon for about $9 each just to try it out. These are great. On non hand / peds rotations I've been using these these for things where I need a little better acuity (eyelids, large vasculature, almost anything on the face) for the last 2 or 3 months.

I have a pair of 4.5x loupes I got my third year because that's when our micro begins. They are the titanium fame SurgiTel ones. I also tried the Zeiss and Designs for Visions ones. I liked SurgiTel the best because the frame is lightest and the nose piece was easily adjustable. These were about $1500 so I had to pay for some of out it out pocket. We do about 50% of our micro with loupes alone and these work fine for that as well as for harvesting the flaps. I've used 6x loupes for about 2 weeks before, and while these were great for micro, it was almost impossible to do anything else.

Some of my coresidents, however, just got 3.5x loupes and use these for everything instead of switching. That's fine too, whatever you like. Ultimately I'm glad with the way this ended up for me. I only use my 4.5x for micro / nerve cases and like I said just keep the 2.5x around my neck all the time and don't have to worry about them.

All this being said, I've never met a resident who said they were dissatisfied with their choice, regardless of what it is. The key is to try out several different things and see what works for you.

 

[310prolene]

Any thoughts between DFV 3.5 extended field, DVF 3.5 micro, and orascoptic hires 3.3/3.8?