Waste Intercostal Neurovascular Bundles Used for Microsurgical Skills Training: Beneficial Inspiration?

Abstract

Microsurgical techniques are becoming more and more important to modern surgery. Microsurgery constitutes the basis of many surgical specialties, such as hand surgery, transplantation surgery, plastic surgery, and neurosurgery, among others. To an increasing extent, junior surgeons need to acquire microsurgical skills to pursue their surgical careers. However, factors such as law, time, and cost can limit the opportunity for or access to microsurgical skills training. Ilie and Chan et al 1,2 conducted a review of the literature, summed up several nonliving training models, and pointed out that none of the models are sufficiently integrative. An optimal model closely simulates real-life conditions so as to facilitate skills transfer, and it is also cost-effective.In this context, we explored the waste intercostal neurovascular bundles of common adult dogs to be used for microsurgical skills training. These dog "spare ribs" came from common dogs that had been used for other scientific research without biohazard and that had to be sacrificed because of specimen collection (Animal protection approval was granted by the Institutional Animal Care Committee). It was attempted to convert the waste into an optimal training resource to reduce expenditure and to reduce the number of animals used for microsurgical skills training. The training model conformed to the 3 R's principle of experimental animals used (3 R's: reduce the number of animals used, replace as many as possible with model, and refine the experimental design). 3 The training strategy has been confirmed to be effective through practice. The main aim of the article is to offer a beneficial inspiration: how to convert some waste experimental animal carcasses into teaching and learning resources. It must be emphasized here that large animals used specially for microsurgical skills training are not advocated absolutely.First, we researched the intercostal anatomy of common adult dogs and found that the anatomical features of intercostal spaces are very similar to those of intercostal spaces in a human body. There is a neurovascular bundle in each intercostal space, which has a strict order: vein-artery-nerve from superior to inferior. The internal intercostal muscles in dogs are smaller than those in human bodies. The parietal pleura cover the inside. The neurovascular bundles can be revealed after the parietal pleura have been incised on the inferior border of the rib and after some connective tissues have been dissected. The diameter of the intercostal arteries, veins, and nerves is approximately 0.4 to 0.6 mm, 0.5 to 0.7 mm, and 0.9 to 2 mm, respectively, which is suitable for training microsurgical skills. The rib, including the neurovascular bundles and the part of the intercostal muscles, was cut into segments of about 5 to 7 cm, wrapped by cling film, and preserved under the condition of -20°C for training microsurgical skills. Of course, the fresh intercostal neurovascular bundles, providing better structure texture of the anatomy, were optimal materials...