J Reconstr Microsurg 2021; 37(06): 514-518
DOI: 10.1055/s-0040-1722184
Original Article

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

Nicholas J. Albano
1  Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Weifeng Zeng
1  Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Christie Lin
2  OnLume Inc., Madison, Wisconsin
3  Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
,
Adam J. Uselmann
2  OnLume Inc., Madison, Wisconsin
,
Kevin W. Eliceiri
2  OnLume Inc., Madison, Wisconsin
3  Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
,
Samuel O. Poore
1  Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
› Author Affiliations
Funding This study was financially supported by the University of Wisconsin, Division of Plastic Surgery.

Abstract

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.

Note

This study is exempted from IRB review as it is characterized as quality improvement and program evaluation. This study was presented as oral presentation in ACAPS Winter Retreat—Austin, TX (February 22, 2020) and ASRM Annual Meeting—Ft. Lauderdale, FL (January 14, 2020).




Publication History

Received: 12 May 2020

Accepted: 04 November 2020

Publication Date:
30 December 2020 (online)

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA