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Basic Microsurgery Course

Purpose of the Teaching and Training Course

To teach the skills required to perform microvascular, microneural, and microtubular surgeries required in a variety of surgical specialties including Plastic Surgery, Orthopedic Surgery, Urology, General Surgery, ENT surgery, Neurosurgery, Otolaryngology, Obstetrics and Gynecology, and Cardiothoracic Surgery. More advanced training is available and is tailored to the individual's needs and interests.

Through one-on-one laboratory instruction and supplemental videos, this Microsurgery Course offers minimum of 40 hours of intensive training in microsurgical techniques for residents, fellows and practicing surgeons. Other members of the team such as: Physician Assistants, Nurses, Researches assisting in microvascular procedures will also benefit.

Upon completion of the course, each participant should have acquired the fundamental microsurgical skills necessary to successfully and confidently dissect, manipulate and repair small vessels.

Employing state-of-the-art, dual-head operating room microscopes, micro-instruments, micro-suture, live animal models, laboratory teaching tissues and non-tissues models, the instructor closely monitors the learning process and provides guidance, assistance, feedback, and skill evaluation throughout the entire course. The course specifically emphasizes proficiency in a patent microvascular anastomosis, tailored to each participant's specialty and areas of interest. During the training we will review basic optical terminology and principles and highlights features of various commercially available loupes.

Basic Microsurgery Course (BMC) will provide Residents and Trainees with an opportunity to acquire a basic orientation to experimental and clinical microsurgery, a learning process to develop superior microsurgical technique(s). In this Course Residents and Trainees focuses to acquire a higher level of basic skills in microvascular surgery by means of intense laboratory practice. This forty hour course involves six to seven sessions which cover the following topics:

Basic Microsurgical Course (40 hours)

  • Session 1: Precondition of Microsurgical Skills
  • Session 2: Basic Microsuture Techniques
  • Session 3: Femoral Artery End-to-End Anastomosis
  • Session 4: Femoral Vein End to End Anastomosis
  • Session 5: Vein interposition graft
  • Session 6: Continuous Suture Technique in End to End Anastomosis
  • Session 7: End to Side Anastomosis

End-to-Side Anastomoses, along with additional advanced microsurgical methods

A certificate of Completion is issued by the Division of Plastic Surgery, McMaster University.

Leading objectives of the Basic Microsurgery Course (BMC)

  1. Explain how to properly use and adjust an operating microscope
  2. Demonstrate proper sitting and hand position towards the sutured, anastomosed object, or animal model
  3. Demonstrate skills necessary to complete microvascular anastomoses, i.e. End-to-End Arterial, End-to-End Venous Anastomosis
  4. Demonstrate skills necessary to complete a continuous microvascular anastomosis
  5. 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.

Basic Microsurgical Course (40 hours, Mon-Fri)*

Practicing Physicians $2500 CAD
Residents & Fellows $2300 CAD

Basic Microsurgical ​Techniques Intro (2 days, Mon-Tues)*

Practicing Physicians $1750 CAD
Residents & Fellows $1500 CAD
 

*Both courses are offered on demand only
*Both courses offer training on rodents

For additional information about the Course Fee please contact:
 

Jen Bowen
Plastic Surgery Residency and Divisional Program Coordinator
Juravinski Hospital B3 -143
711 Concession Street
Hamilton, ON  L8V 1C3
Phone: 905-521-2100 x73962
Fax: 905-528-9388
Email: bowen@mcmaster.ca

Accommodations within walking distance from St. Joseph Hospital

  • Sheraton Hamilton Hotel, 116 King Street West, Hamilton, ON
  • Days Inn Hamilton, 210 Main Street East, Hamilton, ON
  • Admiral Inn, 149 Dundurn Street North, Hamilton, ON
  • Holiday inn Express Hamilton, 51 Keefer Court, Hamilton, ON

For additional information, please contact:

Jen Bowen
Plastic Surgery Residency and Divisional Program Coordinator
Juravinski Hospital B3 -143
711 Concession Street
Hamilton, ON  L8V 1C3
Phone: 905-521-2100 x73962
Fax: 905-528-9388
Email: bowen@mcmaster.ca

Please send an email with the preferred dates to fkonecny@uhnres.utoronto.ca and reserve a position in training courses at least 45 days prior to the initiation of the course. The registration fee for the Basic Microsurgical Course is $300.00 and is refundable.

For additional information please contact:

Jen Bowen
Plastic Surgery Residency and Divisional Program Coordinator
Juravinski Hospital B3 -143
711 Concession Street
Hamilton, ON  L8V 1C3
Phone: 905-521-2100 x73962
Fax: 905-528-9388
Email: bowen@mcmaster.ca

Matt McRae
Plastic Surgery Residency Program Director 
Associate Professor
St. Joseph's Healthcare
50 Charlton Avenue East
Hamilton, ON, L8N 4A6
Phone: (905) 522-1155 x36092

Jen Bowen
Plastic Surgery Residency and Divisional Program Coordinator
Juravinski Hospital B3 -143
711 Concession Street
Hamilton, ON  L8V 1C3
Phone: 905-521-2100 x73962
Fax: 905-528-9388
Email: bowen@mcmaster.ca

Filip Konecny
Plastic Surgery Laboratory
Training Coordinator
101-206 James Street South 
Hamilton, ON, L8P 3A9
Phone: (905) 523-0019 
Fax: (905) 523-0229
Email: filkon76@gmail.com

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