LETTER TO THE EDITOR
MICROSURGERY 00:00–00 2014
MICROSURGERY TRAINING––A HOME DO-IT-YOURSELF MODEL Dear Sir,
With the pressure of time, money, and competition in today’s surgical training, having adequate practice to better our skills is becoming an increasing struggle.1 Attending courses at most, provides a nonlasting familiarity of the various surgical techniques. Additionally, with greater scrutiny of the ethical usage of live animals in teaching microsurgery, simulated models have a role to play in today’s microsurgical training. A variety of live animal alternatives ranging from synthetic materials to chicken leg or thigh have been used.2,3 The main constraints to microsurgical excellence are time at the microscope and access to the equipment. Therefore, we have come up with a Do-It-Yourself Model for Microsurgery Training at home that is cheap, easily reproducible, and above all, realistic. The equipment we used included: a table top microscope with a X5–40 magnification (internal or external lighting); a basic microsurgery kits which consists of needle holders, scalpels, scissors, and forceps. These can be easily procured from Ebay medical training suppliers for less than £200. For our purposes, we found a “Jeff and Jenny” generic table top microscope made in China which adequately served our purpose. This cost £149 from this particular supplier.4 We would like to state that the success of this table top microscope model is that it has an adequate working distance and an option of internal/external lighting to simulate intraoperative conditions. Our 10/0 microsurgical suture material can again be easily bought from online stores based in China for practise.5 Many various sizes are available and come cheap and strong enough for home use. The model we used for simulation was chicken wings from Tesco’s value range which cost Published online 00 Month 2014 in Wiley (wileyonlinelibrary.com). DOI: 10.1002/micr.22242 Ó 2014 Wiley Periodicals, Inc.
Online
Library
under £5. The vessels and nerves on these chicken wings range from 1 to 3 mm which are perfect for our purpose. With the aforementioned equipment and specimen, we were able to experiment with various microsurgery scenarios. The key to microsurgery mastery is regular practice, which this a Do-It-Yourself model permits in the comfort of one’s home, which is significantly cheaper than alternatives. The simplicity of approach and ease of access of materials encourages one to train. We believe that this method of training will not be a substitute for formal microsurgical courses or technical tips from experienced instructors but instead provide a complementary model for trainees who wish to hone or practise their microsurgical skills learnt either on the job or from courses. Without formal microsurgical training or teaching, the learning curve with this Do-It-Yourself will be much longer than a trainee who has had proper guidance. We as trainees have undergone formal microsurgical training but do feel that with this set up easily assembled at home, our increase in technical ability has allowed us to feel more comfortable working on microsurgical cases in the clinical setting. CHARLES YUEN YUNG LOH, M.B.B.S., M.Sc., M.R.C.S. Plastic Surgery Department Aberdeen Royal Infirmary Aberdeen, UK VINCENT TZE YANG TIONG, M.B.B.S. Orthopaedic Surgery Department Aberdeen Royal Infirmary Aberdeen, UK ALEX YUEN HUA LOH University of Edinburgh, UK THANASSI ATHANASSOPOULOS, M.B.B.S., D.M., F.R.C.S. (PLAST) Plastic Surgery Department Ninewells Hospital, Dundee, UK
2
Letter to the Editor
REFERENCES 1. Dean B, Pereira E. Surgeons and Training Time [Internet]. London: BMJ Careers; 2011. Oct 26, [cited 2013 Jun 18]. 2. Ramachandran S, Chui CH-K, Tan B-K. The chicken aorta as a simulation-training model for microvascular surgery training. Arch Plast Surg 2013; 40:327–329.
Microsurgery DOI 10.1002/micr
3. Sch€ offl H, Froschauer SM, Dunst KM, Hager D, Kwasny O, Huemer GM. Strategies for the reduction of live animal use in microsurgical training and education. Altern Lab Anim 2008;36:153–160. 4. Available at: http://www.ebay.co.uk/usr/joy8899. Accessed on February 14, 2014. 5. Available at: www.alibaba.com. Accessed on February 14, 2014.
MICROSURGERY 00:00–00 2014
MICROSURGERY TRAINING––A HOME DO-IT-YOURSELF MODEL Dear Sir,
With the pressure of time, money, and competition in today’s surgical training, having adequate practice to better our skills is becoming an increasing struggle.1 Attending courses at most, provides a nonlasting familiarity of the various surgical techniques. Additionally, with greater scrutiny of the ethical usage of live animals in teaching microsurgery, simulated models have a role to play in today’s microsurgical training. A variety of live animal alternatives ranging from synthetic materials to chicken leg or thigh have been used.2,3 The main constraints to microsurgical excellence are time at the microscope and access to the equipment. Therefore, we have come up with a Do-It-Yourself Model for Microsurgery Training at home that is cheap, easily reproducible, and above all, realistic. The equipment we used included: a table top microscope with a X5–40 magnification (internal or external lighting); a basic microsurgery kits which consists of needle holders, scalpels, scissors, and forceps. These can be easily procured from Ebay medical training suppliers for less than £200. For our purposes, we found a “Jeff and Jenny” generic table top microscope made in China which adequately served our purpose. This cost £149 from this particular supplier.4 We would like to state that the success of this table top microscope model is that it has an adequate working distance and an option of internal/external lighting to simulate intraoperative conditions. Our 10/0 microsurgical suture material can again be easily bought from online stores based in China for practise.5 Many various sizes are available and come cheap and strong enough for home use. The model we used for simulation was chicken wings from Tesco’s value range which cost Published online 00 Month 2014 in Wiley (wileyonlinelibrary.com). DOI: 10.1002/micr.22242 Ó 2014 Wiley Periodicals, Inc.
Online
Library
under £5. The vessels and nerves on these chicken wings range from 1 to 3 mm which are perfect for our purpose. With the aforementioned equipment and specimen, we were able to experiment with various microsurgery scenarios. The key to microsurgery mastery is regular practice, which this a Do-It-Yourself model permits in the comfort of one’s home, which is significantly cheaper than alternatives. The simplicity of approach and ease of access of materials encourages one to train. We believe that this method of training will not be a substitute for formal microsurgical courses or technical tips from experienced instructors but instead provide a complementary model for trainees who wish to hone or practise their microsurgical skills learnt either on the job or from courses. Without formal microsurgical training or teaching, the learning curve with this Do-It-Yourself will be much longer than a trainee who has had proper guidance. We as trainees have undergone formal microsurgical training but do feel that with this set up easily assembled at home, our increase in technical ability has allowed us to feel more comfortable working on microsurgical cases in the clinical setting. CHARLES YUEN YUNG LOH, M.B.B.S., M.Sc., M.R.C.S. Plastic Surgery Department Aberdeen Royal Infirmary Aberdeen, UK VINCENT TZE YANG TIONG, M.B.B.S. Orthopaedic Surgery Department Aberdeen Royal Infirmary Aberdeen, UK ALEX YUEN HUA LOH University of Edinburgh, UK THANASSI ATHANASSOPOULOS, M.B.B.S., D.M., F.R.C.S. (PLAST) Plastic Surgery Department Ninewells Hospital, Dundee, UK
2
Letter to the Editor
REFERENCES 1. Dean B, Pereira E. Surgeons and Training Time [Internet]. London: BMJ Careers; 2011. Oct 26, [cited 2013 Jun 18]. 2. Ramachandran S, Chui CH-K, Tan B-K. The chicken aorta as a simulation-training model for microvascular surgery training. Arch Plast Surg 2013; 40:327–329.
Microsurgery DOI 10.1002/micr
3. Sch€ offl H, Froschauer SM, Dunst KM, Hager D, Kwasny O, Huemer GM. Strategies for the reduction of live animal use in microsurgical training and education. Altern Lab Anim 2008;36:153–160. 4. Available at: http://www.ebay.co.uk/usr/joy8899. Accessed on February 14, 2014. 5. Available at: www.alibaba.com. Accessed on February 14, 2014.
