Training In Microsurgical Techniques Research Articles

Training in microvascular anastomosis - A randomized comparative study between chicken thigh specimen and live rat

Training in microsurgical techniques on live rats is the gold standard, but raises ethical issues related to animal welfare and cost. The aim of this study was to compare acquisition of microsurgical techniques with primary training on chicken thigh specimens. Seventy six students were randomly assigned: 23 to exclusive rat training and 53 to primary chicken-leg training. Both groups were then evaluated on aortic suture and jugular aortic bypass surgery in live rats. The primary criterion for successful anastomosis was the patency test. The survival of the rat, the number of severe vascular wounds and the quality of the dissection were also assessed. Aortic anastomoses were of significantly better quality in the chicken group (p = 0.041). There was no significant difference in the number of serious injuries, rat mortality, or quality of dissection (p > 0.05). For jugular aortic bypass surgery, dissection quality (p = 0.02) and patency test (p = 0.05) were better in the chicken-leg group. There was no significant difference in number of severe wounds or rat mortality (p > 0.05). Students who started their microsurgical training on a chicken leg did not perform worse than those with exclusive live rat training. Initial training on chicken thigh specimens seems to be a reliable alternative to training on live models. Level of evidenceLevel II – Randomized controlled trial.

The lateral supramalleolar flap for the treatment of open foot and ankle fractures

The purpose of this study is to describe the efficacy of lateral supramalleolar flap as an option for soft tissue repair in open fractures of foot and ankle and to present the experience in 2 trauma units: Hospital Susana López de Valencia, Popayán Colombia, and Hospital Universitario de Santander, Bucaramanga Colombia. This is an observational, case series study including all patients with open fractures of foot and ankle who were treated from January 2016 to June 2021 and who required soft tissue coverage. Patients whose soft tissue injury was located on the anatomical area of the perforating peroneal artery, those with less than 6 months of follow-up and those who refused the proposed treatment were excluded. On the other hand, although literature reports flaps of up to 100 cm 2 [1], in our hands, this flap unsuitable for skin defects larger than 60 cm 2 , and other procedures such as free flaps should be considered in these cases. Thirteen patients were selected, 9 men and 4 women, with a mean age of 30 years (12–62 years) and mean follow-up duration of 10.3 months [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. In 11 patients, the mechanism of trauma involved a motorcycle accident. Mean flap size was 40 cm 2 (30–48 cm 2 ). Ten flaps survived with no acute problems, 2 presented with venous congestion and epidermolysis, which were treated conservatively, and 1 developed complete necrosis requiring reintervention. All interventions were performed by the authors belonging to the orthopedic trauma units from the involved hospitals. The lateral supramalleolar flap is an excellent alternative for the treatment of coverage defects caused by open foot and ankle fractures, producing satisfactory and predictable results in the hands of orthopedic surgeons with no specific training in microsurgical techniques. Level of clinical evidence: 4. • The treatment of open distal tibial, ankle, and foot fractures, represents a significant challenge, and it needs early coverage. • Microvascular techniques and free flaps are demanding procedures not always available in trauma centers. • The supramalleolar flap is a reproducible option for soft tissue coverage in distal tibial, ankle, and open foot fractures.

Current Open Surgical Indications for Revascularization in Cerebral Ischemia.

Cerebral revascularization was pioneered half a century ago. Gradual improvements in microsurgical instrumentation and training in microsurgical techniques have allowed significant changes that improved outcomes in neurosurgery, extrapolating this knowledge to other neurosurgical diseases (brain tumor, aneurysms, and skull base tumor surgery). But the popularity of cerebral bypass procedures was followed by their decline, given the lack of clear benefit of bypass surgery in chronic cerebrovascular ischemia after the EC-IC bypass studies. Over the last couple of decades, the formidable advance of neuro-endovascular techniques for revascularization has lessened the need for application of open cerebral revascularization procedures, either for flow augmentation or flow replacement. However, there is still a select group of patients with chronic cerebral ischemia, for whom open cerebral revascularization with flow augmentation is the only treatment option available, and this will be the objective of our current review.

A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery.

Cerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e.g., cadaver, live animal, placenta models). The aim of the present study was to design a readily accessible, realistic, easy-to-build, reusable, and high-fidelity simulator to train neurosurgeons or trainees on vascular anastomosis techniques even in the operating room. The authors used an anatomical skull and brain model, artificial vessels, and a water pump to simulate both extracranial and intracranial circulations. They demonstrated the step-by-step preparation of the bypass simulator using readily available and affordable equipment and consumables. All necessary steps of a superficial temporal artery-middle cerebral artery bypass surgery (from skin opening to skin closure) were performed on the simulator under a surgical microscope. The simulator was used by both experienced neurosurgeons and trainees. Feedback survey results from the participants of the microsurgery course suggested that the model is superior to existing microanastomosis training kits in simulating real surgery conditions (e.g., depth, blood flow, anatomical constraints) and holds promise for widespread use in neurosurgical training. With no requirement for specialized laboratory facilities and regulations, this novel, low-cost, reusable, high-fidelity simulator can be readily constructed and used for neurosurgical training with various scenarios and modifications.

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Sir:FigureWe would like to thank Dr. Corrado Campisi and colleagues for their comments regarding our article entitled “Immediate Breast Reconstruction and Lymphedema Incidence.”1 The authors present a relevant discussion concerning the prevention of lymphatic injuries in breast cancer patients by using microsurgical techniques. By identifying lymphatic disruption at the time of axillary node dissection and performing lymphaticovenous anastomoses between afferent lymphatics and collateral branches of the axillary vein, this technique may allow bypass of injured lymphatics and potential prevention of breast cancer–related lymphedema. The authors report on their recently published prospective randomized study comparing the lymphatic microsurgical preventive healing approach (lymphaticovenous anastomoses) to no intervention in consecutive women undergoing complete axillary dissection.2 A significant difference in lymphedema incidence was found between groups with a follow-up of 18 months. The authors found no difference in age, body mass index, positive lymph nodes, number of lymph nodes removed, radiotherapy, and incidence of cellulitis between the two cohorts. Postoperative compression therapy was not performed in either group. The authors conclude that the lymphatic microsurgical preventive healing approach is a valid technique for prevention of breast cancer–related lymphedema. We applaud the authors for this well-written study and contribution to the literature. As with all procedures aimed at lymphedema prevention and treatment, the question remains: Do these procedures really prevent lymphedema or just delay the onset? Based on a cohort study of patients followed up over a 20-year period, approximately three-fourths of patients will develop breast cancer–related lymphedema in the first 3 years after mastectomy, with the remaining patients developing breast cancer–related lymphedema at a rate of almost 1 percent per year.3 Therefore, longer follow-up is often warranted to assess the effects of radiation fibrosis and the long-term patency of these microsurgical techniques. In addition, the ability of these techniques to prevent lymphedema in the face of future infections, trauma, or weight gain that may occur over a patient's lifetime is still unanswered. Of interest, the authors performed preoperative lymphoscintigraphy in all study patients and used the Kleinhans transport index4–6 to quantify visual findings on lymphoscintigraphy, which was found to have a statistically significant predictive value in identifying at-risk patients. Some women who develop breast cancer–related lymphedema may have lymphatic abnormalities, such as a weaker lymphatic pump or increased lymph flow (or afterload), that predispose them to the development of breast cancer–related lymphedema.7 By potentially using this information and identifying at-risk patients, we may be able to preoperatively select patients for preventative techniques and provide more directed counseling to these patients. This may also balance the cost-benefit of such techniques in the new era of health care cost containment and allow for increased support of specialized training in microsurgical techniques that currently may limit the practicality of its widespread use. We appreciate the comments on our study and look forward to future contributions by Dr. Campisi and his skilled group of colleagues. Melissa A. Crosby, M.D. David W. Chang, M.D. Department of Plastic Surgery University of Texas M. D. Anderson Cancer Center Houston, Texas DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.

Microsurgical techniques using human placenta

Training in microsurgical techniques is the first step to allow procedures in the central nervous system. One of them is the dissection of human placenta. Others include mannequin head1, virtual reality environment2, animal and cadaver dissections3. The human placenta is a maternal-fetal structure constituted of a bigger fetal portion and a smaller maternal portion. The fetal membranes and the placenta are responsible for protection, nutrition, breath, excretion and hormone production4 […] Microsurgical techniques using human placenta

Strategies for the Reduction of Live Animal Use in Microsurgical Training and Education

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80-100%. For an even more enhanced, "closer-to-real-life" scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.

Der freie mikrochirurgische muskuläre Latissimus-dorsi-Lappen des Schweines - In-vitro-Modell zur experimentellen Weiterentwicklung der mikrochirurgischen Rekonstruktion im Kopf-Hals-Bereich

An in-vitro system for research into microsurgical transfer technology in head and neck reconstruction is presented for the first time: the free, muscular latissimus-dorsi-flap of the pig. This in-vitro-system is useful for training in microsurgical techniques, for biomechanical tests of vascular connections, and for the simulation of extracorporal circulatory systems in free flaps. This in-vitro system corresponds to human surgical conditions and anatomical proportions. It helps reduce the number of animals needed in microsurgical research and therefore complies with present legislation. The article outlines the surgical technique of raising and replanting the free flap and its cold storage.

Interactive advanced-communication multistation system for microsurgical training.

The use of cameras in microscopes is not in itself new; however, this paper describes a new use of microscope-mounted cameras in conjunction with an audio intercom system for training in microsurgical techniques. The application of new technology may enhance traditional microsurgical training. Our objective was to compare the opinions of students attending training courses before and implementation of an interactive training system. This qualitative, descriptive study analyzed the results of end-of-course satisfaction surveys carried out among 400 students (physicians and veterinarians), 240 before and 160 after implementation of the system. Compared to the conventional system used previously at the Minimally Invasive Surgery Center and still in use elsewhere, most students felt that monitoring, training, and troubleshooting were both easier and more thorough using the multistation system. The "multistation system" allows real-time, one-to-one, tutor-student interaction, obviating the need for the tutor to move from student to student, and allowing him to monitor activity at the same working magnification as the student. As a result, the level of student satisfaction has improved.

Laboratory training in microsurgical techniques and microvascular anastomosis

It should never be forgotten that there is far more to microsurgery than the mere possession of a highly perfected optical instrument. Without bipolar coagulation, specialized instruments, and, above all, knowledge and skill in atraumatic microtechniques, the microscope alone is of little value. Perfection of atraumatic microsurgical technique is best acquired by operating on small-diameter blood vessels (0.8 mm to 1.5 mm) in animals.

Microsurgical training using pig legs

In order to train microsurgeons, instead of using living animals, a realistic non-living model has been used. The front legs of pigs are suitable for training in microsurgical techniques because the microscopic and gross anatomy of the pig's front leg corresponds well to that of the human upper extremitiy.