Supermicrosurgery training model for lymphaticovenous anastomosis in advanced lymphedema by iliolumbar vein and ureter anastomosis in the rat

Malagón, Paloma; Carrasco‐López, Cristian; Vilà, Jordi; Pí-Folguera, J.; Higueras-Suñe, Carmen

doi:10.1002/micr.30445

Cited by 8 publications

(6 citation statements)

References 5 publications

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Section: Discussionmentioning

confidence: 58%

“…49,75 In response to this allegation, the ureter (average diameter, 0.61 mm) and the iliolumbar vein (average diameter, 0.38 mm) of rats have been proposed to convey a realistic model for LVA in patients with advanced stage lymphedema. 35 Remarkably, the size of these vessels and the wall-to-lumen ratio are similar to cases of lymphedema with an International Society of Lymphology stage IIb and III, where the wall of the lymphatic vessel is thickened and the lumen has progressively narrowed. 35,76 In comparison to in vivo models, the chicken wings, thighs, and legs were predominantly used as ex vivo models.…”

Section: Plastic and Reconstructive Surgery • May 2023mentioning

confidence: 58%

“…35 Remarkably, the size of these vessels and the wall-to-lumen ratio are similar to cases of lymphedema with an International Society of Lymphology stage IIb and III, where the wall of the lymphatic vessel is thickened and the lumen has progressively narrowed. 35,76 In comparison to in vivo models, the chicken wings, thighs, and legs were predominantly used as ex vivo models. These had multiple advantages, including low costs, easy storage and disposal, reduced preparation time, tissue similarities, and no ethical concerns.…”

Section: Plastic and Reconstructive Surgery • May 2023mentioning

confidence: 58%

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Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Escandón

Ciudad²,

Poore

et al. 2022

Plastic &Amp; Reconstructive Surgery

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ince first described, supermicrosurgery has been broadly accepted and implemented because of a superior and widespread knowledge of the anatomy of perforators and of lymphatic surgery. [1][2][3][4] In fact, the technical considerations and applications of supermicrosurgery are currently incorporated in different fields Background: Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical dexterities. The authors aimed to present a systematic review and meta-analysis of preclinical experimental models and simulation platforms used for supermicrosurgery. Methods: An electronic search was conducted across the PubMed MEDLINE, Embase, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data collection included the types of experimental models and outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model. Results: Thirty-eight articles were incorporated in the qualitative synthesis. Twenty-three articles reported the use of in vivo models (60.5%), 12 used ex vivo models (31.5%), and three used synthetic models (7.9%). The superficial inferior epigastric system of rats was the most common in vivo model, whereas chicken wings and hindlimbs were the most common methods used in ex vivo models. The most common methods to evaluate patency of anastomoses were gross inspection, passage of nylon thread into the lumen, and intravascular flow of an injected dye. Nineteen studies were incorporated in the meta-analysis. The overall rate of a successful anastomosis was 94.9% (95% CI, 92.3 to 97.5%). The success rate of in vivo models using rats was 92.5% (95% CI, 88.8 to 96.3%). The success rate of ex vivo models was 97.7% (95% CI, 94.6 to >99%). Conclusion: Simulators that have high fidelity concerning the dissection of the vascular pedicle, flap elevation, supermicrovascular anastomosis, and adequate assessment of a successful anastomosis possess adequate predictive validation to evaluate and simulate the supermicrosurgical technique. (Plast. Reconstr. Surg. 151: 775e, 2023) Clinical Relevance Statement: Supermicrosurgical simulators are designed to reproduce specific clinical scenarios; therefore, these should be implemented sequentially to develop specific competencies. Supermicrosurgical models must be regarded as mutually inclusive learning platforms to optimize the learning curve.

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Section: Discussionmentioning

confidence: 58%

Section: Plastic and Reconstructive Surgery • May 2023mentioning

confidence: 58%

Section: Plastic and Reconstructive Surgery • May 2023mentioning

confidence: 58%

See 1 more Smart Citation

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Escandón

Ciudad²,

Poore

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Additionally, fat necrosis requiring reoperation can result in significant breast deformity and consequent emotional distress and increased medical costs. Recently, the use of ICG angiography in DIEP flap breast reconstruction has been demonstrated to be associated with a reduced risk of fat necrosis (26), and the incidence of fat necrosis has been shown to range from 8.3% to 29% among patients who have undergone intraoperative ICG angiography (27)(28)(29)(30)(31). Three studies have demonstrated intraoperative ICG administration to be associated with decreased rate of fat necrosis, and subjective assessment of ICG enhancement has been used to determine the area to be excised (28,29,31).…”

Section: Discussionmentioning

confidence: 99%

Influence of vertical location and spacing of perforators on perfusion in deep inferior epigastric artery perforator flap breast reconstruction: quantitative analysis using indocyanine green angiography

Park¹,

Lee²,

Woo³

2022

Gland Surg

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Background: This study quantitatively assessed perfusion of the deep inferior epigastric artery perforator (DIEP) flap according to vertical location and vertical spacing of perforators during DIEP flap breast reconstruction. Methods:In 67 patients who underwent unilateral DIEP flap breast reconstruction between November 2018 and August 2021, flap perfusion was intraoperatively assessed using indocyanine green angiography.Perforators located at or above the umbilicus were defined as vertical zone 1 perforators and those below the umbilicus as vertical zone 2 perforators. Perfusion assessment was conducted in two stages: at stage 1, perfusion solely by single dominant perforators was assessed. At stage 2, the perfusion increment effected by adding a single additional perforator was assessed. Perfused area proportions were compared between patients with dominant perforators in zone 1 versus zone 2. The effect of adding an additional perforator to another vertical zone ("vertical spacing") was also assessed.Results: The perfused proportion was significantly higher among vertical zone 2 perforators compared with zone 1 perforators in the evaluation of single dominant perforators (70% vs. 56%; P<0.001). In the evaluation of incremented perfusion by single additional perforators, the perfused proportion was significantly higher in the vertical-spacing group compared to the no-vertical-spacing group (17% vs. 12%; P=0.004). Fat necrosis developed in 4.5 percent of the patients over at least 6 months of follow-up.Conclusions: DIEP flap perfusion can be affected by the vertical location of perforators, and flap perfusion can be augmented effectively by vertical spacing of perforators.

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“…While many excellent surgical training models exist, few have been described for supermicrosurgery. [5][6][7][8] The University of Wisconsin "blue-blood" chicken thigh model -a perfused chicken thigh using blue colored saline-serves as…”

mentioning

confidence: 99%

Augmentation of Chicken Thigh Model with Fluorescence Imaging Allows for Real-Time, High Fidelity Assessment in Supermicrosurgery Training

Albano

Zeng

Lin

et al. 2020

J Reconstr Microsurg

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Background The skills required for supermicrosurgery are hard-earned and difficult to master. The University of Wisconsin “blue-blood” chicken thigh model incorporates perfusion of the thigh vessels with a blue liquid solution, allowing users to visualize flow across their anastomoses. This model has proven to be an excellent source of small vessels (down to 0.3 mm) but assessing the quality of anastomoses at this spatial scale has proven difficult. We evaluated whether fluorescent imaging with indocyanine green (ICG) in this realistic training model would enhance the assessment of supermicrosurgical anastomoses, and therefore improve real-time feedback to trainees. Methods Anastomoses of vessels ranging from 0.35 to 0.55mm in diameter were performed followed by the capture of white light with and without fluorescence imaging overlay during infusion of “blue-blood” and ICG. Videos were randomized and shown to seven fellowship-trained microsurgeons at the University of Wisconsin-Madison who rated each anastomosis as “patent,” “not patent,” or “unsure.” Surgeon accuracy, uncertainty, and inter-rater agreement were measured for each imaging modality. Results Use of fluorescence significantly increased surgeon accuracy to 91% compared with 47% with white light alone (p = 0.015), decreased surgeon uncertainty to 4% compared with 41% with white light alone (p = 0.011), and improved inter-rater agreement from 53.1% with white light alone to 91.8% (p = 0.016). Conclusion Augmentation of the University of Wisconsin “blue-blood” chicken thigh model with ICG fluorescence improves accuracy, decreases uncertainty, and improves inter-rater agreement when assessing supermicrosurgical anastomoses in a training setting. This improved, real-time feedback enhances this model's value as a supermicrosurgical training tool.

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Supermicrosurgery training model for lymphaticovenous anastomosis in advanced lymphedema by iliolumbar vein and ureter anastomosis in the rat

Cited by 8 publications

References 5 publications

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Influence of vertical location and spacing of perforators on perfusion in deep inferior epigastric artery perforator flap breast reconstruction: quantitative analysis using indocyanine green angiography

Augmentation of Chicken Thigh Model with Fluorescence Imaging Allows for Real-Time, High Fidelity Assessment in Supermicrosurgery Training

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