title: A Novel Ex Vivo Training Model for Acquiring Supermicrosurgical Skills Using a Chicken Leg.
abstract: BackgroundSupermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg.MethodsIn 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested.ResultsWe were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable.ConclusionDue to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Cifuentes
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: José R
authors.initials: JR
authors.lastname: Rodriguez
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Yañez
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: María C
authors.initials: MC
authors.lastname: Salisbury
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Álvaro J
authors.initials: ÁJ
authors.lastname: Cuadra
authors.affiliation: Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Julian E
authors.initials: JE
authors.lastname: Varas
authors.affiliation: Section of Plastic and Reconstructive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Bruno L
authors.initials: BL
authors.lastname: Dagnino
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education* / Q000379:methods; D000818:Animals; D002645:Chickens; D002983:Clinical Competence; D004210:Dissection / Q000193:education* / Q000379:methods; D004503:Education, Medical, Graduate; D035002:Lower Extremity / Q000033:anatomy & histology / Q000601:surgery*; D008866:Microsurgery / Q000193:education*; D055806:Microvessels / Q000033:anatomy & histology / Q000601:surgery*; D023421:Models, Animal; D061646:Operative Time; D014656:Vascular Surgical Procedures / Q000193:education*