Step By Step Free Flap Training Based on Inferior Superficial Epigastric Vessels in Rats

Abstract

Introduction: Skill, knowledge and experience are essential in the field of microsurgery. The repetitive practice of free flaps on reliable models represents a valuable asset for each young surgeon, simulating the challenges of a free flap, before attempting human complex reconstructions. Microsurgery free-flap training is a demanding challenge, with limited options depending on local and regional programs, therefore we comprised a practice system that would add and reinforce microsurgical skills of each aspiring surgeon. Materials and Methods: Wistar rats, weighing 300-400 grams were used, the epigastric flap presenting the advantage of low morbidity with possibility of primary closure, while the donor cervical site represents a recipient area with one of the lowest chances of post-surgical self-mutilation areas in murine models. Results: The aim of this paper is to present a step-wise approach on a reliable training model, using living Wistar rats specimens. Microsurgery and super-microsurgery techniques are trained by harvesting a fascio-cutaneous free flap and transferring it to the cervical area. The aforementioned flap presents a pedicle based on the superficial inferior epigastric vessels at the emergence from the femoral vessels which will be anastomosed to an anterior cervical created defect to the carotid artery end-to-side and to the external jugular vein end-to-end, the epigastric vein presenting a diameter of 0.7-0.8 mm and the epigastric artery a diameter of 0.5-0.6 mm. They can be harvested with patches or stumps of femoral vessels for microsurgical training as an easier entry-level option, or directly for super-microsurgical training. Conclusion: This flap represents a reliable living training model, which can develop microsurgical skills involving raising, transferring and in-setting free flaps, providing ample and valuable knowledge and practice, simulating the challenges of a real-life either microsurgical or super-microsurgical intervention.