Step By Step: Microsurgical training method combining two nonliving animal models

The overall goal of the following experiment is to develop a microsurgical training method, combining two non-living animal microsurgical models. For a trainee with no previous microsurgical experience, A microscopical dissection of a commercially available chicken thigh is recommended first to expose the femoral artery, vein and nerve. The tissue is then placed under the microscope to perform the desired microsurgical technique.

For example, an end-to-end suture of the chicken femoral artery. When the trainee is comfortable working with the thigh tissue, the procedure can then be practiced with a smaller brachial artery found in commercially available chicken wings. Ultimately, perfecting these microsurgical techniques with the chicken femoral and brachial arteries can prepare the neurosurgeon for work in smaller live animal models and in clinical scenarios.

The main advantage of this technique over another existing like Micros Soldier training with rat is that our technique doesn't need a anesthesia and also doesn't need dedicated facilities minimizing economical stances and animal sacrifice. The femoral vessels and sciatic nerve of the chicken thigh can easily be exposed by running a finger just medial to the femoral shaft. The femoral head can then be observed near the dissection plane, which is located just parallel to the femoral shaft to practice an end-to-end anastomosis with the one way up technique on the chicken femoral artery.

Next place the tissue under the microscope. The location of the femoral artery vein and sciatic nerve should now be observed. Free the artery from the underlying tissues and divided horizontally.

Then using micro pickups and micro scissors, trim any adventitia overlying the arterial lumen, followed by a rinse of the inner lumen with regular tap water. If time training, record the start time, then place the first stitch starting on the back wall of the femoral artery on the far side of the tissue, and passing the needle from the outside of the artery towards the lumen, and then from the lumen to the outside of the artery to tie the stitch. Perform a double knot first, followed by two single throws in alternating directions.

Then complete the whole back wall, passing the needle back and forth as just demonstrated. Next place a single stitch on the front wall of the vessel from the outside to the lumen, and then from the lumen to the outside. Then tie the knot as just demonstrated, completing the front wall using single stitches as previously described.

And record the finish. Time to practice on the chicken brachial artery. First, use scissors to incise the skin longitudinally from the shoulder up to the tip of the wing.

The artery can now be observed running between the biceps and triceps brachii as indicated by the arrowheads heads. To test the patency of either microsurgical procedure, cross a smooth 20 or 27 gauge angio catheter through the anastomosis to check for obstructions. Then attach a syringe loaded with commercial food colorant to the end of the catheter and perfuse the dye into the artery to test for leakage.

Finally open the artery longitudinally to visualize the stitches, their parallelism, and the amount of wall taken here. A microscopic image of e femoral artery end-to-end suture is shown achieved by a one-way up technique with single stitches as just demonstrated. Whereas in this image, a representative end-to-end suture of a chicken brachial artery is presented.

The brachial artery is much smaller than the femoral artery, resulting in a much more technically demanding procedure. The chicken thigh model is very versatile, allowing for different types of practice exercises. Indeed, in this representative experiment, a femoral artery repair with a vein graft harvested from the femoral vein was performed.

After watching that video, you should have a good understanding how to make an end-to-end artery anastomosis or e femoral or rial chicken artery as well. How to assess the pregnancy of your results shots.