Training in Microvascular Surgery Using a Chicken Wing Artery

OBJECTIVEMicroarterial anastomosis is now seldom performed for treatment of atherosclerotic occlusive cerebrovascular disease. However, a small but significant number of procedures still require this technique. When a surgeon’s clinical experience is limited, regular practice is required to maintain and improve surgical skills. The present training system involves passage from suturing of synthetic materials (such as Silastic tubes) to practice with experimental living animals or cadavers. However, these methods are neither convenient nor practical for daily exercises and rehearsals. I present a unique training exercise for microarterial anastomosis, using a chicken wing artery. METHODSA brachial artery can be extracted from a chicken wing. The artery is 5 to 6 cm long and measures approximately 1 mm in diameter. The artery can be used to practice end-to-end, end-to-side, or side-to-side anastomosis under the microscope. RESULTSSeveral advantages are noted: the materials are cheap, convenient to manage, and easy to obtain, and neither specific facilities to maintain living animals nor anesthesia is needed. Moreover, the diameter and structure of the material are identical to those of human cortical vessels, making the rehearsal quite similar to the actual surgical experience. CONCLUSIONThis exercise is useful not only for young surgeons who wish to learn microsurgical techniques but also for more experienced surgeons who need to maintain or improve their skills.

[1]  A. Zarabini,et al.  [From surgical gloves to the rat. The various stages of microsurgery learning]. , 2000, Minerva chirurgica.

[2]  T. Sundt,et al.  Neurovascular microsurgery: a model for laboratory investigation and the development of technical skills. , 1976, Mayo Clinic proceedings.

[3]  G. Green,et al.  Training in microvascular surgery. , 1977, Surgery.

[4]  Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. , 1985, The New England journal of medicine.

[5]  V. Fischer,et al.  In search of the “perfect” anastomosis , 1990, Microsurgery.

[6]  S. Freys,et al.  [Education and training in microsurgery without experiments on live animals]. , 1988, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....

[7]  N. Matsumura,et al.  Side-to-side arterial anastomosis model in the rat internal and external carotid arteries. , 2001, Journal of reconstructive microsurgery.

[8]  M. Yașargil CHAPTER 4 – Reconstructive and Constructive Surgery of the Cerebral Arteries in Man , 1969 .

[9]  L. Sekhar,et al.  Cerebral Revascularization for Aneurysms and Tumors , 2002, Neurosurgery.

[10]  M. Lan,et al.  Rat femoral vein‐to‐vein grafts as a microvascular practice model: Factors that influence patency , 1991, Microsurgery.

[11]  G. Austin,et al.  A laboratory model for vascular microsurgery. , 1983, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  M. Wexler,et al.  Microsilicone anastomoses. , 1983, Annals of plastic surgery.

[13]  P. Karl,et al.  [The technic of microvascular anastomoses: the rat as a model]. , 1977, Zeitschrift fur experimentelle Chirurgie.

[14]  W. Shaw,et al.  The microvascular technique of vein grafting in rats as a training and experimental model , 1980, Journal of microsurgery.

[15]  Lippincott Williams Wilkins,et al.  The International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis (EC/IC Bypass Study): methodology and entry characteristics. The EC/IC Bypass Study group. , 1985, Stroke.

[16]  J. Ausman,et al.  Critique of the extracranial-intracranial bypass study. , 1986, Surgical neurology.