Leading objectives of the Basic Microsurgery Course (BMC)
- Explain how to properly use and adjust an operating microscope
- Demonstrate proper sitting and hand position towards the sutured, anastomosed object, or animal model
- Demonstrate skills necessary to complete microvascular anastomoses, i.e. End-to-End Arterial, End-to-End Venous Anastomosis
- Demonstrate skills necessary to complete a continuous microvascular anastomosis
- Demonstrate ability to complete End-to-Side and Interpositional Vein Grafts
The model Animal in all studies is Rat. Please inform the Instructor of any know allergies i.e. animal saliva, dandruff, urine, or surgical latex and etc. before the BMC.
** All Animal Utilization Protocols are used in BMC are for teaching purposes only and are deemed to be non-survival.
Session 1: Precondition of Microsurgical Skills
- Acquaintance with operating microscope
- Hand position when holding instruments
- Control of hand tremor
- Needle-holding position (forehand or backhand)
- Handling microsurgical sutures and instruments
- Microsurgical equipment set-up
- Microsurgical instrument care
Session 2: Basic Microsuture Techniques
- Introduction to microsurgery and laboratory procedures
- Use of the microsurgical needle holder and forceps
- Basic suturing technique
- Passing the needle through tissue
- Tying a microsurgical knot
- Learning to handle microsurgical instruments
- Developing basic microsurgical suturing techniques for both hands
Practice on stretched rubber glove and tubing with addition of practice with the adjustment of surgical field with concentration on the proper pedal switch coordination
Practice on a rubber glove and 1 mm tubing with 9-0 microsuture
Explanation of basic principles, instrument use, and body and hand positions
Session 3: Femoral Artery End-to-End Anastomosis (FAEEA)
- FAEEA is performed by the instructor with the trainee assisting; all under the teaching microscope. The rat femoral artery is accessed and cleaned between the inguinal ligament and the superficial epigastric branch, approximately 0.8 to 1 mm in diameter. 10-0 microsutures are used. Basic aspects of the FAEEA are discussed.
- Several FAEEA are performed by the trainee. The instructor assists and guides the trainee to prevent introduction of improper techniques that may later delay development and perfection. Upon completion trainee should be well versed in the basic technique.
Session 4: Femoral Vein End to End Anastomosis (FVEEA)
- FVEEA is done by the instructor with the trainee assisting; all under the teaching microscope. Observing of differences between arterial and venous anastomoses and particular problems associated with FVEEA are discussed. The anastomosis of rat femoral vein (approximate 0.9 to 1.1 mm in diameter) is performed with 10-0 suture.
- Venous anastomosis by the trainee with the instructor observing, and if necessary, correcting technique.
Session 5: Femoral Vein Interposition Graft (FVIG)
- FVIG of femoral vein graft and (superficial epigastric vein graft) interpositioned to femoral artery are performed by the trainee with the instructor assisting; all under the teaching microscope. Later, the superficial epigastric vein (approximately 0.6 to 0.7 mm in diameter) can be attempted to graft. 10-0 sutures are used. Discussed are vein grafting techniques, indications and complications.
Session 6: Continuous Suture Technique in End to End Anastomosis
The training of continuous end to end anastomosis can be done in the groin area on the Femoral Artery with the Femoral Vein graft or the same procedure can be attempted on the Carotid Artery grafting either Femoral Artery or Femoral Vein.
- Important is to observe the positioning of the needle holder and needle towards the grated artery as well the amount of suture necessary to prepare and sizing of bites on the artery and graft.
- All continuous techniques are discussed and practiced in both regions.
Session7: End to Side Anastomosis
- Arterial End to Side Anastomosis is trained in this session.
Observing and learning of technical differences between end-to-end anastomosis and end-to-side anastomosis is taught.
- Arterio-Venous Anastomosis with arterial end to venous side.
Learning problems associated with joining vessels with different wall thickness. Training that can be later requested include:
- Vascular free graft (latissmus dorsi muscular flap)
Transplantation of the latissimus dorsi muscular free flap based on the thoraco-dorsal vessels is performed by the trainee with the instructor assisting. Discussion of the vascular anatomy, and advantages and disadvantages of the muscle flap compared with the cutaneous free flap.
- Vascular free graft (groin cutaneous flap)
Re-plantation of the groin cutaneous free flap based on the superficial epigastric vessels in continuity with the femoral vessels is performed by the trainee with the instructor assisting.
Discussion of the cutaneous flap vascular anatomy associated with problems of flap dissection.
* All Animal Utilization Protocols are used in BMC are for teaching purposes only and are deemed to be non-survival.