Microsurgical training regimen with nonliving chicken models

Multiple microsurgical models have been described for the training of microsurgical trainees, such as hand fellows. Living animal models, specifically rats, are the standard of training today. However, a microsurgical lab that allows for continuous rat training is not always available and sometimes this option is not feasible due to economic or ethical concerns. In some fellowship programs, ours and other similar ones, there has been a noted decrease in replants and flaps caused by traumatic injuries. A surgical fellow may not be consistently presented with the opportunity to practice his microsurgical skills in daily patient care. Inert living models such as silicone tubes, gloves, and complex nonliving models are readily available but bear little resemblance to the clinical situation. These are commonly only used as an introduction to microsurgical training with animals. Nonliving animal or human tissue models are rarer and generally used less often. Cadavers, chicken wings, chicken trachea and esophagus, turkey wings, chicken thighs, and chicken drumsticks have all been described as possible training models. Nonliving animal tissues are relatively cheap and easy to find at the local supermarket and they have been suggested as an alternative to prevent animal deaths. Different vessel sizes can be achieved by purchasing different pieces of meat. This allows the trainee to experience microsurgery under different conditions. Several of the models also include nerve tissue that allows practicing different types of nerve repair in a controlled environment. We present a regimen for continuous training of microsurgery based purely on animal nonliving models, and its economical impact. Since January 2012, several of our clinical fellows have practiced their microsurgical skills to different degrees using chicken thighs and chicken wing pieces bought at the local supermarket (Kroger Co, Cincinnati, OH). Our training regimen is based on two nonliving models; first the chicken wing model described by Hino, and secondly the chicken thigh model first described by Marsh et al. and later modified by Jeong et al. Both models have strengths and weaknesses. The chicken thigh model for continuous training is very versatile and permits training on nerves, veins, arteries, as well as allowing for more complex procedures. The drawbacks of this particular model is the size of the vessels and nerve, the artery is reported to be 2.04 6 0.17 mm in diameter, the vein 1.45 6 0.06, and the nerve 1.24 6 0.08 mm. These are slightly bigger than the diameters reported in the literature for human digital arteries which are reported to range from 1.37 to 0.80 mm depending on the studied finger. We used this model in the initial phases of training. It allows easy practice of the basic microsurgical techniques and also prevents frustration of the trainee which can ensue from practice with smaller vessels. So the trainee could get used to handling smaller vessels, we introduced the chicken wing model to the fellow’s training The wing artery of chicken is reported to be 1.07 6 0.25 mm in diameter, closer to the *Correspondence to: Dr. Jose Couceiro M.D. Ph.D., F.E.B.O.T., Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202. E-mail: couceirox@gmail.com