Design and creation of an experimental program of advanced training in reconstructive microsurgery

Lorenzo, Andres Rodriguez; Alvarez, Angel; Garcia‐Barreiro, Juan; Centeno, Alberto; Lopez, Eduardo; Martelo, Francisco

doi:10.1002/micr.20265

Cited by 15 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An advanced training program in microsurgery was proposed including five types of free tissue transfer exercises, to evaluate microsurgical skills of the trainee by clinical monitoring. 21 This program adds greater complexity to the microsurgical training and allows the trainee to extend his or her microsurgical skills beyond vascular anastomosis into flap design, bony fixation, and so on. However, it is a time-consuming exercise.…”

Section: Discussionmentioning

confidence: 99%

Rat Tail Revascularization Model for Advanced Microsurgery Training and Research

Şakrak

Köse²,

Karabağli³

et al. 2011

J reconstr Microsurg

View full text Add to dashboard Cite

We describe a time-saving microsurgical exercise for continuing microsurgical training and research. The rat tail replantation model was simplified by excluding bone detachment. Rats were divided into two groups: devascularization only ( N = 3) and revascularization after devascularization ( N = 7). The tail was devascularized by ligation and division of artery and veins in the first group to reveal if a collateral circulation from bone existed. The divided vessels were reanastomosed in the second group. The circulation of the rat tails was followed for 1 week. The tails showed total necrosis in the devascularization group, whereas only two of seven tails showed partial necrosis in the revascularization group. Reexploration showed thrombosis narrowing the lumen at the anastomotic site of the partially necrosed tails, most likely due to an anastomotic insufficiency. The present study revealed that total amputation is not necessary for tail devascularization. The rat tail revascularization model provides a practical tool for advanced and continuing microsurgical training and research.

show abstract

Section: Discussionmentioning

confidence: 99%

Rat Tail Revascularization Model for Advanced Microsurgery Training and Research

Şakrak

Köse²,

Karabağli³

et al. 2011

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…1,2,14 Microsurgical courses which have been established at many centres successfully are exclusively based on exercise models using either alloplastic materials, mostly silicone sheets or acrylic tubes, 8,9,[15][16][17][18][19][20] vessels derived from animals like coronary arteries of the pig or cow, 10,[19][20][21] or programs on living animals, nearly always rats. 5,17,20,[22][23][24][25] Especially working on living animals provides for realistic conditions comparable to those of the clinical setting, 5,17,20,[22][23][24][25] but apart from the fact that these animals have to be sacrificed, this kind of exercise produces relatively high costs, 9,17,19 and often meet with disapproval in the public. Apart from this it was shown that microsurgical skills also can be acquired on so called prosthetic models.…”

Section: Discussionmentioning

confidence: 99%

Thiel embalming technique: A valuable method for microvascular exercise and teaching of flap raising

et al. 2008

View full text Add to dashboard Cite

Because of its high requirements on dexterity and microsurgical skills and the need of complete understanding of flap anatomy, microvascular free flap transfer belongs to the most demanding surgical procedures. Therefore, courses for flap raising and microvascular exercise are considered a prerequisite to prepare for clinical practise. To achieve teaching conditions as realistic as possible we used a novel cadaver embalming method enabling tissue dissection comparable to the living body. Thirty cadavers which were offered to us by the Institute of Anatomy for the purpose of running flap raising courses were embalmed in the technique described by Thiel. On each cadaver, nine free flaps were dissected according to a structured protocol by each course participant and afterwards used for microvascular exercise. The conservation of fine vascular structures and the suitability of the embalmed tissue for microvascular suturing were observed and photographically documented. The Thiel embalming technique provided flap raising procedures to be performed under realistic conditions similar to the living body. Vessels and nerves could be exposed and dissected up to a diameter of 1 mm and allowed for microvascular suturing even after weeks like fresh specimens. The Thiel embalming method is a unique technique and ideally suited to teach flap raising and microvascular suturing on human material.

show abstract

“…Irrespective of the microsurgical technique, whether the purpose of training is to integrate new skills or improve on Fig. 2 Result after microsurgical end-to-side training (diameter = 2.2 mm, magnification 940) and permeability test conducted by injecting water into the earthworm using a syringe existing ones, significant amounts of time must be invested, which conflicts with the constraints faced by residents [13,14]. After extensive training on different animal models such as pigs, rats, rabbits, chicken, and fish [15], and also on discarded abdominoplasty specimens, we have been searching for a new model that can provide a solution to the following issues associated with basic training: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention laboratories that are closed on weekends.…”

Section: Discussionmentioning

confidence: 99%

Is There Good Simulation Basic Training for End-To-Side Vascular Microanastomoses?

et al. 2013

View full text Add to dashboard Cite

Background Microvascular anastomosis is the cornerstone of free tissue transfers. Irrespective of the microsurgical technique that one seeks to integrate or improve, the time commitment in the laboratory is significant. After extensive previous training on several animal models, we sought to identify an animal model that circumvents the following issues: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention that laboratories are closed on weekends. Methods Between January 2012 and April 2012, a total of 91 earthworms were used for 150 microsurgical training exercises to simulate vascular end-to-side microanastomosis. The training sessions were divided into ten periods of 7 days. Each training session included 15 simulations of end-to-side vascular microanastomoses: larger than 1.5 mm (n = 5), between 1.0 and 1.5 mm (n = 5), and smaller than 1.0 mm (n = 5). A linear model with the main variables being the number of weeks (as a numerical covariate) and the size of the animal (as a factor) was used to determine the trend in time of anastomosis over subsequent weeks as well as the differences between the different size groups. Results The linear model shows a significant trend (p \ 0.001) in time of anastomosis in the course of the training, as well as significant differences (p \ 0.001) between the groups of animals of different sizes. For microanastomoses larger than 1.5 mm, the mean anastomosis time decreased from 19.3 ± 1.0 to 11.1 ± 0.4 min between the first and last week of training (decrease of 42.5 %). For training with smaller diameters, the results showed a decrease in execution time of 43.2 % (diameter between 1.0 and 1.5 mm) and 40.9 % (diameter \1.0 mm) between the first and last periods. The study demonstrates an improvement in the dexterity and speed of nodes execution. Conclusion The earthworm appears to be a reliable experimental model for microsurgical training of endto-side microanastomoses. Its numerous advantages are discussed here and we predict training on earthworms will significantly grow and develop in the near future.

show abstract

Design and creation of an experimental program of advanced training in reconstructive microsurgery

Cited by 15 publications

References 26 publications

Rat Tail Revascularization Model for Advanced Microsurgery Training and Research

Rat Tail Revascularization Model for Advanced Microsurgery Training and Research

Thiel embalming technique: A valuable method for microvascular exercise and teaching of flap raising

Is There Good Simulation Basic Training for End-To-Side Vascular Microanastomoses?

Contact Info

Product

Resources

About