January 14, 2015
1:15:12pm
WSPC/135-HS
FA1
1520002
Hand Surgery, Vol. 20, No. 1 (2015) 199–200 © World Scientific Publishing Company DOI: 10.1142/S0218810415200026
SHORT COMMUNICATION THE CHICKEN FOOT DIGITAL REPLANT TRAINING MODEL Thanassi Athanassopoulos* and Charles Yuen Yung Loh† *Department
of Plastic and Reconstructive Surgery Ninewells Hospital, Dundee, Scotland
†Department
of Plastic and Reconstructive Surgery Aberdeen Royal Infirmary, Aberdeen, Scotland
Received 5 April 2014; Revised 3 July 2014; Accepted 4 July 2014; Published 20 January 2015 ABSTRACT A simple, readily available digital replantation model in the chicken foot is described. This high fidelity model will hopefully allow trainees in hand surgery to gain further experience in replant surgery prior to clinical application. Keywords: Microsurgery; Replant; Training Model; Chicken.
Digital replantation requires the successful sequential execution of fundamental techniques in hand surgery: Stable bony fixation; extensor and flexor tendon repair; digital artery and nerve repair and venous anastomosis.1 From a training perspective replants can be daunting, and therefore we explored the use of the chicken foot digit as a means to simulate the sequence of steps involved. The dorsal vasculature of the chicken foot has previously been described as a high fidelity model of microvascular anastomosis.2 although we are the first to describe the use of the chicken foot digit as a model for digital replantation. Chicken feet were obtained from the local Chinese supermarket at minimal cost. The anatomy of the chicken foot digit is similar to the human digit, with similar phalanges and tendons and neurovasculature. The skin surrounding the digit was carefully dissected to demonstrate the underlying anatomy. The digital arteries are located more dorsal than their human counterparts and are
derived from branches of the dorsalis pedis and medial plantar artery.3 The injury was created using sharp dissection circumferentially and a mini hack-saw (Black and Decker) was used to divide the bone. It is important to keep the tissues moist with saline, as they dessicate rapidly under the microscope. Bony fixation was achieved with 99 wiring.4 Microvascular anastomosis was performed with 10/0 Ethilon (Fig. 1). The diameter of the digital vessels was under 1mm testing microsurgical skill and tissue handling. Patency was tested by flushing the larger proximal dorsal vessel with a blunt needle.2 We found that this model of digital replantation to be very effective for simulation of the procedure. The model is cheap and readily available and each step can be repeated individually to gain experience. Although challenging, it permits the trainee to learn and rehearse the operative steps and consider the technical difficulties that are encountered.
Correspondence to: Mr. Thanassi Athanassopoulos, Plastic Surgery Resident, Middlemore Hospital, New Zealand. Mailing address: 1D/11 Pakenham Street East, Auckland Central, Auckland 1010, New Zealand. Tel: (þ64) 210-850-2422, E-mail: [email protected] 199
January 14, 2015
200
1:15:12pm
WSPC/135-HS
FA1
1520002
T. Athanassopoulos & C. Y. Y. Loh
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008. There were no live animal experiments performed and animals were sourced from high street shops that held animals according to UK welfare law (TA, CL). Statement of informed consent Identifying information, including patients’ names, initials, or hospital numbers, has not been published. There are no individuals that have been identified in this paper (TA, CL).
References Fig. 1 Long toe of chicken foot with 90-90 wiring in situ and digital vessel repair (inset).
ACKNOWLEDGEMENTS Conflict of interest The authors (TA, CL) have no conflict of interest to report. Statement of human and animal rights
1. Wood MB, Finger and hand replantation. Surgical technique, Hand Clin 8(3):397–408, 1992. 2. Satterwhite T et al., The chicken foot dorsal vessel as a high-fidelity microsurgery practice model, Plast Reconstr Surg 131(2):311e–312e, 2013. 3. Vamhidy L et al., Anatomy of the chicken foot for the experimental investigation in flexor tendon surgery, Acta Chir Hung 35(1–2):21–33, 1995. 4. Zimmerman NB, Weiland AJ, Ninety-ninety intraosseous wiring for internal fixation of the digital skeleton, Orthopedics 12(1):99–103; discussion 103–104, 1989.
Copyright of Hand Surgery is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
1:15:12pm
WSPC/135-HS
FA1
1520002
Hand Surgery, Vol. 20, No. 1 (2015) 199–200 © World Scientific Publishing Company DOI: 10.1142/S0218810415200026
SHORT COMMUNICATION THE CHICKEN FOOT DIGITAL REPLANT TRAINING MODEL Thanassi Athanassopoulos* and Charles Yuen Yung Loh† *Department
of Plastic and Reconstructive Surgery Ninewells Hospital, Dundee, Scotland
†Department
of Plastic and Reconstructive Surgery Aberdeen Royal Infirmary, Aberdeen, Scotland
Received 5 April 2014; Revised 3 July 2014; Accepted 4 July 2014; Published 20 January 2015 ABSTRACT A simple, readily available digital replantation model in the chicken foot is described. This high fidelity model will hopefully allow trainees in hand surgery to gain further experience in replant surgery prior to clinical application. Keywords: Microsurgery; Replant; Training Model; Chicken.
Digital replantation requires the successful sequential execution of fundamental techniques in hand surgery: Stable bony fixation; extensor and flexor tendon repair; digital artery and nerve repair and venous anastomosis.1 From a training perspective replants can be daunting, and therefore we explored the use of the chicken foot digit as a means to simulate the sequence of steps involved. The dorsal vasculature of the chicken foot has previously been described as a high fidelity model of microvascular anastomosis.2 although we are the first to describe the use of the chicken foot digit as a model for digital replantation. Chicken feet were obtained from the local Chinese supermarket at minimal cost. The anatomy of the chicken foot digit is similar to the human digit, with similar phalanges and tendons and neurovasculature. The skin surrounding the digit was carefully dissected to demonstrate the underlying anatomy. The digital arteries are located more dorsal than their human counterparts and are
derived from branches of the dorsalis pedis and medial plantar artery.3 The injury was created using sharp dissection circumferentially and a mini hack-saw (Black and Decker) was used to divide the bone. It is important to keep the tissues moist with saline, as they dessicate rapidly under the microscope. Bony fixation was achieved with 99 wiring.4 Microvascular anastomosis was performed with 10/0 Ethilon (Fig. 1). The diameter of the digital vessels was under 1mm testing microsurgical skill and tissue handling. Patency was tested by flushing the larger proximal dorsal vessel with a blunt needle.2 We found that this model of digital replantation to be very effective for simulation of the procedure. The model is cheap and readily available and each step can be repeated individually to gain experience. Although challenging, it permits the trainee to learn and rehearse the operative steps and consider the technical difficulties that are encountered.
Correspondence to: Mr. Thanassi Athanassopoulos, Plastic Surgery Resident, Middlemore Hospital, New Zealand. Mailing address: 1D/11 Pakenham Street East, Auckland Central, Auckland 1010, New Zealand. Tel: (þ64) 210-850-2422, E-mail: [email protected] 199
January 14, 2015
200
1:15:12pm
WSPC/135-HS
FA1
1520002
T. Athanassopoulos & C. Y. Y. Loh
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008. There were no live animal experiments performed and animals were sourced from high street shops that held animals according to UK welfare law (TA, CL). Statement of informed consent Identifying information, including patients’ names, initials, or hospital numbers, has not been published. There are no individuals that have been identified in this paper (TA, CL).
References Fig. 1 Long toe of chicken foot with 90-90 wiring in situ and digital vessel repair (inset).
ACKNOWLEDGEMENTS Conflict of interest The authors (TA, CL) have no conflict of interest to report. Statement of human and animal rights
1. Wood MB, Finger and hand replantation. Surgical technique, Hand Clin 8(3):397–408, 1992. 2. Satterwhite T et al., The chicken foot dorsal vessel as a high-fidelity microsurgery practice model, Plast Reconstr Surg 131(2):311e–312e, 2013. 3. Vamhidy L et al., Anatomy of the chicken foot for the experimental investigation in flexor tendon surgery, Acta Chir Hung 35(1–2):21–33, 1995. 4. Zimmerman NB, Weiland AJ, Ninety-ninety intraosseous wiring for internal fixation of the digital skeleton, Orthopedics 12(1):99–103; discussion 103–104, 1989.
Copyright of Hand Surgery is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
