Microsurgery and the community-based plastic surgeon.

1. The majority of our residents who completed their training since 1974 use a microscope for nerve repairs. A majority of those doing microscopic nerve repairs also repair noncritical vessel injuries with the microscope. 2. Half of the respondents who completed training in 1974 or before do not use the microscope for any operative procedures. 3. Successful replantation or revascularization procedures are not uncommon early in the practice of a community-based plastic surgeon. The tendency is to do fewer of these procedures the longer the period of practice. 4. For most of the community-based plastic surgeons, the boundary line of community practice versus the University practice is at the level of replantation, revascularization, and free flaps. 5. This boundary was modified by the strategy of having a University microsurgeon (from the same respondent group) assist the community-based plastic surgeon on replants and free flaps in a community hospital. 6. All of the residents who completed training since 1978 used loupes on a frequent (daily or weekly) basis. 7. Only half of the residents who completed training before 1975 used loupes. 8. Other uses of the microscope in the community were vasectomy reversal, nailbed repair, individual transplantation of hairs for eyelashes, canaliculus repairs, and the prevention of traumatic tattoos. Otologic and laryngologic procedures were carried out under the microscope by two respondents who had had otorhinolaryngologic training prior to their plastic surgery residencies.