Transdermal silicone patch for improving comfort in loupe‐aided surgery

Abstract

Loupe magnification is widely used in surgery. Hand surgeons, in particular, use magnification for virtually all cases. The physical examination is more effective with magnification including improved tissue and foreign body identification.1 They are useful in replantations down to the palmar arch and free flaps with vessels more than 1.5 mm, such as the latissimus, fibula, serratus, radial forearm, rectus abdominis, dorsalis pedis, omentum, and jejunum.2 However, loupes are indicated in all interventions which require accuracy in identifying and handling small anatomical structures, as for example in pediatric surgery. Several factors should be taken into account when choosing surgical loupes. First of all, resolution of the loupes is obviously important. Another important consideration is the width of the loupe field. Usually, surgeons prefer a large field width, since a wider loupe field allows the surgeon to keep his instruments in perspective with the area of focus. Other important roles are played by the working angle of the loupes and the weight of the instrument (most surgeons prefer lighter frames to minimize strain). Loupes must be comfortable for the operator and therefore the weight of the loupes is an important consideration. If the loupes are too heavy they can be uncomfortable to wear—especially during long procedures. Loupes are usually mounted on spectacle frames and a good quality frame will distribute the weight evenly around the nose bridge and ears. However, all the surgeons who make frequent use of loupes have experienced, particularly during long operations, a discomfort due to the weight of the loupes and in some cases real pain. It's common to see the application of patches at the back of the nose to reduce the trauma at the level of support points of loupes. However, upon removal of the patch is frequently de-epithelization and traumatism in this site. For this reason we suggest a little trick to minimize discomfort during prolonged use of microsurgical loupes. It's common practice for anesthesiologists to place a transdermal silicone eye mask, that could be refrigerated, to reduce the risk of ocular trauma to the patient during surgery and anesthetic procedures. This product is also used after plastic surgeries and cosmetic treatments that involve the eye/upper nose area. The immediate application of cold therapy is beneficial for reducing post-operative swelling by constricting the capillary vessels and slowing down the flow of blood and other fluids to the injured or operated area and reduce the hematoma risk. It is possible to cut out the central fragment from this reusable silicone mask that perfectly fit the contour of the nasal dorsum as shown in Figures 1 and 2. The weight is then distributed over the nose and the particular consistency of the silicone avoids traumatizing the epidermis. The central fragment from this reusable silicone eye mask is cut. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] The fragment perfectly fit the contour of the nasal dorsum greatly improving the comfort of the surgeon. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] With this little trick the comfort of the surgeon will be greatly improved. Finocchi Valerio M.D.*, Tambasco Damiano M.D.*, * Division of Plastic and Reconstructive Surgery Catholic University of the Sacred Heart Rome, Italy