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Three-dimensional (3D) video exoscopes are high-magnification stereo cameras that project onto monitors mounted in the operating room, viewable from different angles. Outside of plastic surgery, exoscopes have been shown to successfully improve the ergonomics of microsurgery, though sometimes with prolonged operating times. We compare a single surgeon's early experience performing free flap procedures from 2020 to 2021 using either a binocular microscope or a 3D video exoscope. Ten procedures were performed with the standard operating microscope and 8 procedures with the 3D exoscope. The microsurgeon, having minimal prior experience using an exoscope, reported less neck discomfort following the free flap procedures performed with the exoscope compared with the binocular surgical microscope. Total average operating time was comparable between the standard surgical microscope and the 3D exoscope (13.7 vs. 13.4 hours, p = 0.34). Our early experience using a 3D exoscope in place of a standard optical microscope demonstrated that the exoscope shows promise, offering an ergonomic alternative during microvascular reconstruction without increasing overall operating times. Future studies will compare free flap ischemia time between cases performed using the exoscope and the conventional binocular microscope. Medical Subject Headings authorized following words: free tissue flaps; operating rooms; ergonomics; microsurgery.

Summary:. Due to the relative paucity of cases, there are no well-founded protocols for the management of large auricular arteriovenous malformations (AVMs) that are based on a significant number of cases. Recommendations in the literature generally separate resection of the malformation from a later reconstruction of the ear to allow for a period of disease-free status to minimize the risk of recurrence. This interval between resection and reconstruction can be cosmetically challenging for working adult patients. As auricular AVMs are often localized to the external ear, amputation is likely curative, and reconstruction should be considered at the time of resection. We present an adult male patient with a markedly enlarged left external ear secondary to a congenital AVM. The AVM was managed by auricular amputation without prior embolization. Immediate ear reconstruction was then performed using a porous polyethylene implant covered with an ipsilateral temporoparietal fascia flap. The flap was supplied by the superficial temporal artery. After 3 years, the patient has a cosmetically acceptable ear, with no signs of recurrence of the vascular malformation.