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J Reconstr Microsurg 2017; 33(02): 087-091
DOI: 10.1055/s-0036-1592428
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Training with the Three-Step Approach

Emilio Trignano
1   Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy
,
Nefer Fallico
2   Department of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
,
Gino Zingone
1   Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy
,
Luca Andrea Dessy
2   Department of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
,
Gian Vittorio Campus
1   Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy
› Author Affiliations
Further Information

Publication History

17 July 2016

08 August 2016

Publication Date:
12 October 2016 (online)

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Abstract

Background Microsurgery is very challenging, requiring a high degree of dexterity and manual skills that should be fully trained outside of the operating room. Common microsurgery courses usually follow a stepwise training approach beginning practice on nonliving models and proceeding with live rats. However, training on live rats raises certain issues, including ethical concerns as well as the associated costs. As such, there is an increasing drive toward alternative models. The current article describes a three-step training approach (latex glove–endovascular prosthesis–human placenta), which aims to prepare trainees for the clinical direct application. Also, to validate it, this approach was compared with microsurgical training on rats.

Methods Overall, 20 residents were randomly assigned to two different microsurgical training courses, each based on one of the aforementioned approaches. Residents were evaluated in terms of correct handling of the instruments, correct use of the microscope, adventectomy, triangulation technique, posterior wall technique, success of the end-to-end anastomosis, and ability in assisting the tutor during the arterial anastomosis.

Results The three-step and the live rats groups evidenced similar scores in term of acquired basic skill levels.

Conclusions The three-step model allows to progressively gain skills on microsurgical techniques and to perform a good vascular anastomosis without the need of further steps on rats. The availability of both endovascular prosthesis and human placenta makes this training model definitely accessible from a practical and logistical point of view.

Keywords

microsurgery - microsurgical training - models in microsurgery

Supplementary Material

 

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