title: [Not Available].
abstract: BACKGROUND
  Since the pioneering work of Jacobson and Suarez, microsurgery has steadily progressed and is now used in all surgical specialities, particularly in plastic surgery. Before performing clinical procedures it is necessary to learn the basic techniques in the laboratory.
  
  
  OBJECTIVE
  To assess an animal model, thereby circumventing the following issues: ethical rules, cost, anesthesia and training time.
  
  
  METHODS
  Between July 2012 and September 2012, 182 earthworms were used for 150 microsurgical trainings to simulate discrepancy microanastomoses. Training was undertaken over 10 weekly periods. Each training session included 15 simulations of microanastomoses performed using the Harashina technique (earthworm diameters >1.5 mm [n=5], between 1.0 mm and 1.5 mm [n=5], and <1.0 mm [n=5]). The technique is presented and documented. A linear model with main variable as the number of the week (as a numeric 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 differences between the different size groups.
  
  
  RESULTS
  The linear model showed 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 animal of different sizes. For diameter >1.5 mm, mean anastomosis time decreased from 19.6±1.9 min to 12.6±0.7 min between the first and last week of training. For training involving smaller diameters, the results showed a reduction in execution time of 36.1% (P<0.01) (diameter between 1.0 mm and 1.5 mm) and 40.6% (P<0.01) (diameter <1.0 mm) between the first and last weeks. The study demonstrates an improvement in the dexterity and speed of nodes' execution.
  
  
  CONCLUSIONS
  The earthworm appears to be a reliable experimental model for microsurgical training of discrepancy microanastomoses. Its numerous advantages, as discussed in the present report, show that this model of training will significantly grow and develop in the near future.
authors: Department of Plastic and Hand Surgery, Inselspital, University of Bern, Switzerland; ; Department of Plastic and Hand Surgery, Institut Gustave Roussy, Villejuif, France;
authors: Franck Marie P
authors: FM
authors: Leclère
authors: Department of Plastic and Hand Surgery, Institut Gustave Roussy, Villejuif, France;
authors: Frédéric
authors: F
authors: Kolb
authors: North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA;
authors: Gregory A
authors: GA
authors: Lewbart
authors: Department of Plastic Surgery, CHU Bordeaux, Bordeaux, France.
authors: Vincent
authors: V
authors: Casoli
authors: Department of Plastic and Hand Surgery, Inselspital, University of Bern, Switzerland;
authors: Esther
authors: E
authors: Vögelin
keywords: Earthworms; Experimental model; Microanastomoses; Microsurgery