BackgroundApplications of microsurgery are evolving and expanding within oral and maxillofacial surgery (OMS).1 While a variety of surgical subspecialties are embracing microsurgery as a core component of their training programs, a validated microsurgery curriculum in the OMS specialty is lacking. Microsurgery requires fine motor skills developed with consistent practice and frequent exposure, which is ideally obtained early in training and developed over time and experience. Unfortunately, many barriers exist that limit residents from achieving early exposure and competence in microsurgery upon residency graduation.2 The objective of this study was to evaluate 2 low-cost microscopes and 2 simulation vessels for use in a training curriculum. The primary outcome was readiness of the simulation to be used in a microsurgical curriculum. Secondary outcomes were realism, value, usefulness, difficulty, and cost of the simulation. MethodsA microvascular anastomosis simulation exercise was developed. Seven surgeons were tasked with completing an end-to-end anastomosis on both a silicone vessel and a chicken thigh femoral artery vessel on 2 table-top microscopes. These microscopes were a monocular digital microscope (Plugable USB 2.0 Digital Microscope) and a binocular stereo microscope (AmScope 7x-45x Stereo Binocular Microscope). The surgeons comprising the expert panel were all microvascular-trained surgeons in the departments of oral and maxillofacial surgery (n = 5), plastic and reconstructive surgery (n = 1), and otolaryngology (n = 1). The surgeons performed the simulation independently, without an assistant. Upon completion of the simulation, the surgeons were asked to complete a survey to evaluate the simulation across multiple domains. Likert responses were coded into numeric values (e.g., “strongly disagree” = 1, “somewhat disagree” = 2, etc.), and means and standard deviations were reported. Paired T-tests were used to compare responses to analogous questions regarding the microscopes and simulation vessels. Analyses were performed in SAS V9.4 (SAS Institute Inc., Cary, NC, USA). ResultsSeven surgeons completed the simulation exercise and survey. The stereo microscope simulation scored significantly higher in “readiness for use” in a microsurgery curriculum than the digital microscope (P = .002). All 7 surgeons indicated that the stereo microscope simulation, in conjunction with silicone and chicken vessels, could be used in a microsurgery curriculum in its current state (n = 4) or with minimal modification (n = 3). All 7 respondents indicated that the digital microscope simulation required considerable modification (n = 4) or extensive modification with re-evaluation (n = 3) before use. The stereo microscope significantly outperformed the digital microscope in depth perception (P < .001), field of view (P = .038), lighting (P = .038), and clarity (P = .030). The respondents strongly agreed that the binocular microscope was a low-cost and high-value training simulation (mean: 4.86 out of 5.00, SD = 0.38). Both microscopes were “very useful” for practicing microsurgical technique, allowing early access to training and improving hand-eye coordination. The chicken vessel significantly outperformed the silicone vessel in realism of tissue handling (P < .001), passing the needle (P = .007), vessel orientation (P = .035), and knot-tying (P = .005). ConclusionA microsurgical training curriculum using the stereo or digital table-top microscopes in conjunction with chicken thigh or silicone vessels demonstrates value for OMS residency education, with the stereo microscope and the chicken thigh outperforming their counterparts. The microsurgery simulation is a low-cost, high-value option that is ready for use in microsurgery training.