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J Reconstr Microsurg 2016; 32(07): 528-532
DOI: 10.1055/s-0036-1581077
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence and Type of Errors in Microsurgical Technique in Surgical Trainees

Jill P. Stone
1   Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
,
Christopher C. Doherty
2   Division of Plastic Surgery, Department of Surgery, University of Western Ontario, London, Canada
,
Christiaan H. Schrag
1   Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
› Author Affiliations
Further Information

Publication History

19 August 2015

04 February 2016

Publication Date:
06 April 2016 (online)

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Abstract

Background The purpose of our study was first to identify microsurgical errors and their incidence. Identifying these common errors and the theoretical approach to prevent or repair them may provide benefit to trainees in the laboratory setting and, ultimately, in the clinical setting.

Methods Using a rat femoral artery anastomoses model for resident microsurgical training, direct staff observation with real-time feedback and error identification was employed. Types of microsurgical errors were recorded and instructor feedback relayed to five resident participants.

Results Errors were cataloged into five main categories: insufficient approximation (26.1%), vessel backwall (21.7%), incomplete bites (19.6%), tissue tear (19.6%), and irregular widths (13.0%). Further subdivision of the incomplete bite error based on vessel layer violated was performed. Representative figures were created outlining these errors.

Conclusions We present common microsurgical errors in trainees and a training model with synchronous feedback. Visual images were designed outlining these errors as an adjunct for teaching.

Keywords

microsurgery - surgical training - surgical errors - residency training
 

  • References

  • 1 Sidhu RS, Park J, Brydges R, MacRae HM, Dubrowski A. Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. J Vasc Surg 2007; 45 (2) 343-349
    CrossrefPubMedGoogle Scholar
  • 2 Chan WY, Figus A, Ekwobi C, Srinivasan JR, Ramakrishnan VV. The ‘round-the-clock’ training model for assessment and warm up of microsurgical skills: a validation study. J Plast Reconstr Aesthet Surg 2010; 63 (8) 1323-1328
    CrossrefPubMedGoogle Scholar
  • 3 Balasundaram I, Aggarwal R, Darzi LA. Development of a training curriculum for microsurgery. Br J Oral Maxillofac Surg 2010; 48 (8) 598-606
    CrossrefPubMedGoogle Scholar
  • 4 Bates BJ, Wimalawansa SM, Monson B, Rymer MC, Shapiro R, Johnson RM. A simple cost-effective method of microsurgical simulation training: the turkey wing model. J Reconstr Microsurg 2013; 29 (9) 615-618
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Furka I, Brath E, Nemeth N, Miko I. Learning microsurgical suturing and knotting techniques: comparative data. Microsurgery 2006; 26 (1) 4-7
    CrossrefPubMedGoogle Scholar
  • 6 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63 (8) 1329-1334
    CrossrefPubMedGoogle Scholar
  • 7 Scholz M, Mücke T, Hölzle F , et al. A program of microsurgical training for young medical students: are younger students better?. Microsurgery 2006; 26 (6) 450-455
    CrossrefPubMedGoogle Scholar
  • 8 Ramachandran S, Ghanem AM, Myers SR. Assessment of microsurgery competency-where are we now?. Microsurgery 2013; 33 (5) 406-415
    CrossrefPubMedGoogle Scholar
  • 9 Grober ED, Hamstra SJ, Wanzel KR , et al. Validation of novel and objective measures of microsurgical skill: hand-motion analysis and stereoscopic visual acuity. Microsurgery 2003; 23 (4) 317-322
    CrossrefPubMedGoogle Scholar
  • 10 Selber JC, Chang EI, Liu J , et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012; 130 (4) 550e-557e
    CrossrefPubMedGoogle Scholar
  • 11 Di Cataldo A, La Greca G, Rodolico M, Candiano C, Li Destri G, Puleo S. Experimental models in microsurgery. Microsurgery 1998; 18 (8) 454-459
    CrossrefPubMedGoogle Scholar
  • 12 Temple CLF, Ross DC. A new, validated instrument to evaluate competency in microsurgery: the University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument [outcomes article]. Plast Reconstr Surg 2011; 127 (1) 215-222
    CrossrefPubMedGoogle Scholar
  • 13 Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skill-acquisition series part 1: validated microsurgical models—a systematic review. J Surg Educ 2014; 71 (3) 329-338
    CrossrefPubMedGoogle Scholar
  • 14 Lorenzo AR, Alvarez A, Garcia-Barreiro J, Centeno A, Lopez E, Martelo F. Design and creation of an experimental program of advanced training in reconstructive microsurgery. Microsurgery 2006; 26 (6) 421-428
    CrossrefPubMedGoogle Scholar
  • 15 Kalu PU, Atkins J, Baker D, Green CJ, Butler PEM. How do we assess microsurgical skill?. Microsurgery 2005; 25 (1) 25-29
    CrossrefPubMedGoogle Scholar
  • 16 Schoffl H, Froschauer SM, Hainisch R , et al. Intraluminal endoscopic evaluation of microvascular anastomosis. J Plast Reconstr Aesthet Surg 2008; 61 (4) 388-392
    CrossrefPubMedGoogle Scholar
  • 17 Shi G, Meister D, Daley RA, Cooley BC. Thrombodynamics of microvascular repairs: effects of antithrombotic therapy on platelets and fibrin. J Hand Surg Am 2013; 38 (9) 1784-1789
    CrossrefPubMedGoogle Scholar
  • 18 Nam SM, Shin HS, Kim YB, Park ES, Choi CY. Microsurgical training with porcine thigh infusion model. J Reconstr Microsurg 2013; 29 (5) 303-306
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Brosious JP, Tsuda ST, Menezes JM , et al. Objective evaluation of skill acquisition in novice microsurgeons. J Reconstr Microsurg 2012; 28 (8) 539-542
    Article in Thieme ConnectPubMedGoogle Scholar