COVID-19 lockdown and beyond: Home practice solutions for developing microsurgical skills.

Abstract

Correspondence and Communications COVID-19 lockdown and beyond: Home practice solutions for developing microsurgical skills. Dear Sir, Current COVID-19 restrictions present significant challenges to Plastic Surgery training. Numerous obstacles exist; including the necessity for social distancing, global PPE shortages, virtual clinics decreasing trainee exposure to pathology, reduced face-to-face clinical teaching, and limited time in theatre. 1 Furthermore, suspension of nonurgent elective reconstruction work, including breast reconstruction, limits microsurgical training opportunities. Surgical training relies on multiple sequential practice sessions, to allow deep encoding into "muscle memory" 2 , this is particularly relevant for microsurgery where fine motor skills need to be developed. The authors present multiple practical and cost-effective solutions that allow trainees to practice microsurgical techniques from home and "upskill anywhere". These practice options are transferrable to other periods away from clinical practice, including research time and maternity leave, and can also be used to supplement clinical experience during unpredictable on-call rotas. In climates of economic instability, these techniques may prove particularly beneficial. A basic microsurgical instrument kit may be purchased online from multiple platforms at a relatively low cost (e.g. AliEx-press TM , £34). The cost of microsurgical sutures can be a limiting factor to microsurgical practice (e.g. 9.0 AliExpress TM , £0.93 each) and in the context of the COVID-19 pandemic, precarious supply chains necessitate preservation of resources. Luangjarmekorn et al. describe the use of human hair and insulin needles (BD Ultra-Fine Pen Needles 4 mm × 32 G, expresschemist.co.uk, £0.13 each) to make homemade microsurgical sutures (Table 1). Feedback from trainees in their study suggested that human hair sutures (Figure 1) was a "good-excellent" standard for microsurgical practice, equal to that of standard sutures 3. This is reflected in our experience; we find that a hair of dark colour, mid length, coarse texture and wavy consistency works best. There are multiple models for microsurgical practice described in the literature, including live animal models (predominantly rats), non-live animal models such as chicken wings or thighs, pig leg, placenta vessels, and cold stored vessels. Additionally, a number of non animal models exist

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“…6 Additionally, the novel Coronavirus disease 2019 (COVID-19) has further presented significant challenges to microsurgical training, as cancellation of elective surgeries has reduced operative volume and trainees' time under an operating microscope. 7,8 In March 2020 alone, U.S. hospitals lost between 30 to 55% of elective surgical case volume. 9 In April 2020, a survey distributed to members of the American Council of Academic Plastic Surgeons showed that over 95% of respondents reported their institution had prohibited all elective surgery that month.…”

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“…Thus, despite a rapidly changing landscape, plastic surgeons have remained steadfast in the pursuit of excellent patient care, rigorous education, and the safety and longevity of the community. From embracing telehealth and virtual educational platforms to the use of 3-D printing in order to address shortages in personal protective equipment, 4 , 5 the plastic surgeon continues to adapt and innovate. Plastic surgery journals and their editorial teams have played an invaluable role in this process.…”