Chicken thigh microvascular training model improves resident surgical skills

Abstract

ObjectivesMicrosurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills.Study DesignValidation studyMethodsThirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator.ResultsThere was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance.ConclusionsThe chicken thigh model demonstrates objective improvements in resident microvascular surgical skills.Level of EvidenceNA

Microsurgery Training in Plastic Surgery

“…The chicken thigh model has demonstrated objective improvement in microvascular skills and a significant decrease in anastomosis time. 18 – 20 In this model, there was a statistically significant decrease between the time required to complete the first stitch (235 seconds, 95% confidence interval, 198–272 seconds) and the time required to complete the last stitch (120 seconds; 95% confidence interval, 92–149 seconds), an average 48.7% (115 seconds) decrease in time ( P < 0.001). Junior (postgraduate year 2–3) and senior (postgraduate year 4–5) residents had similar decreases in time (49.1% and 48.21%, respectively).…”

“…The classic specimens used for training are chicken, rat, and porcine models. 18 – 28 Chicken specimens are readily available and inexpensive, making them a popular choice for microsurgery simulation. The chicken aorta, which measures approximately 4 mm in diameter, has been reported to be effective to practice microvascular anastomosis.…”

“…Junior (postgraduate year 2–3) and senior (postgraduate year 4–5) residents had similar decreases in time (49.1% and 48.21%, respectively). 18 The femoral neurovascular bundle has been used for micro-anastomosis practice, demonstrating efficiency in performance. 21 The chicken wing model has also been used to learn microsurgical skills with the advantages of being affordable and readily available with similar blood vessel diameter to humans.…”

Current status of simulation and training models in microsurgery: A systematic review

“…Since most identified models were not supported by a great number of validation studies, they received a lower LoR. The cryopreserved rat aorta model(Kim et al, ; Ghanem et al, ) which used anastomosis lapse index tool for skills assessment was the only model, overall, to receive a LoR of 1, with chicken thigh(Creighton et al, ; Schoeff et al, ) and chicken wing(Jusue‐Torres et al, ; Kaplan et al, ) models receiving a LoR of 2. Similar to animal cadaveric tissue models, human cadaveric tissue models have also been used and are considered superior to animal cadaveric models in terms of offering correct anatomy, consistency and similar texture of the tissue to humans.…”

“…The chicken aorta model (Ramachandran et al, ) owing to its large lumen size (4 mm) is suitable to help build confidence in the novice microsurgeons. The chicken thigh model (Creighton et al, ; Schoeff et al, ; Pafitanis et al, ) demonstrated objective improvement in the microvascular surgical skills of the residents and a significant reduction in the time required to complete the anastomosis. Jeong et al () found that using the femoral neurovascular bundle of the chicken leg to practice the microanastomosis also demonstrated efficiency in anastomosis performance.…”