Microsurgical Training Model for Nerve Repair

Acute injuries of the extremities require that microsurgical procedures be mastered for a number of procedures, including revascularization and the suturing of nerves and flaps. Therefore, the microsurgical team not only requires a thorough basic education, but also ongoing laboratory training for skill maintenance. Laboratory training models are essential for the development and refinement of microsurgical techniques.[1] Proficient microsurgical technique can be acquired using anesthetized rats or rabbits, animal preparations, or synthetic models; however, ethical considerations, the costs involved, and legislation controlling experiments with animals all favor a move toward reduction in the number of animal experiments.[2]

A new non-animal microsurgical training model for nerve repair that has not been reported in the literature is described. For this study, we used covered rubber thread, in imitation of nerve, and Steristrip. A covered rubber thread is depicted containing many round rubber elements. We wrapped Steristrip around the rubber for stabilization after the rubber was cut. The covered rubber thread was placed under the microscope (Fig. [1]). A 10-0 monofilament polyamid 6-75 μm suture was used to place two stay stitches (Fig. [2]). Nerve transfer was the next step in this model. For these latter exercises, a simulated defect made by covered rubber thread stood in for a nerve gap. Several rubber segments were used to insert into the gap as a nerve graft.

Figure 1 Covered rubber thread under the microscope.

Figure 2 Sutured covered rubber thread has a similar view to nerve repair.

Many microsurgical training models exist. These can be broadly classified into animal and non-animal. The non-animal models that are commonly used in microsurgical training can involve rubber glove material, placenta, colored beads, polyethylene transparent film membrane, and surgical gauze, among others.[3] [4] [5]

Covered rubber thread provides a readily available, safe material to achieve initial dexterity. There is no need to go to the animal laboratory. This is the first report in the literature for a non-animal microsurgical training model for nerve repair. Compared with the use of anesthetized laboratory animals, practicing microsurgical techniques on synthetic models offers practical and financial advantages. Synthetic models provide every member of a surgical team with a convenient opportunity to practice microsurgery at any time without assistance, and exercises can be interrupted and resumed. Therefore, considering the ethical implications legislation concerning the protection of animals, and financial arguments, a reduction in the number of animal experiments is likely.[2] A special advantage of our model is that a structural view of the rubber simulates a structural view of the nerves in human extremities.

REFERENCES

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• 2 Weber D, Moser N, Rösslein N. A synthetic model for microsurgical training: a surgical contribution to reduce the number of animal experiments.  Eur J Pediatr Surg. 1997;  7 204-206
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