Intro and Methods: Retrospective review of H&N free tissue transfers (FTT) performed within University of Rochester using 3.5x loupes-only for magnification.

Results: 210 loupe-only FTT’s were performed on 195 patients, 70% male and 30% female. 93% malignant, 7% benign. Defects included oral cavity (54%), maxilla/orbit/skull base (12%), soft tissue/scalp (14%), Oropharynx/palate (16%), and larynx/hypopharynx (4%). FTT's used were radial forearm (58%), fibula (21%), rectus (13%), other (8%). The most common recipient vessels were the EC artery (61%) and the IJ vein (76%), followed by the facial artery (18%) and facial vein (8%). Arterial anastamosis was end to side 50%, side to side 50%. Venous configuration was E-S 75%, S-S 25%. 9.0 Nylon was used for 61% of arterial anastamoses, and 91% of venous anastamoses. No couplers were used for this series. The total flap success rate was 97.9%. Total complication rate was 26.3%. Complications included pneumonia (3.7%), infection, fistula and dehiscence (6.3%) and hemorrhage/hematoma (3.1%), total flap loss (2.1%), partial flap loss (2.1%), flap thrombosis (2.1%)

Conclusions: Microvascular reconstruction with loupes-only can successfully be applied to a myriad of Head and Neck defects. This can be performed with 3.5x magnification with acceptable complication rates and excellent overall flap success.