OUTCOMES OF A LONG-TERMS MICROVASCULAR TRAINING FOR RESIDENTS IN ORTHOPEDIC

The acquisition of specific technical skills in the field of microsurgery like the use of operating microscope and microsurgical instruments, arterial and venous anastomosis, vascular grafts, nerve sutures and tenorrhaphies, is very important during the training in Orthopedics and in Hand Surgery in order to deal with management of complex and amputative traumas of the upper limb. The learning curve in microsurgical techniques is significantly shortened for surgeons who benefit from pre-clinical courses on an animal model. The aim of this study was to standardize a long-term microsurgical activity during the training in Orthopedics and Hand Surgery and to document the benefits that the residents of the School of Specialization got by chance of practicing weekly this discipline on in-vivo model. In 2016, a protocol for teaching in vivo microsurgery on Wistar rats for orthopedics and hand surgery residents was approved. In the first 3 years of graduation course, the students performed the training aimed at acquiring manual dexterity and confidence with the microsurgical instrumentations on nonliving models. Subsequent exercises were performed ex vivo on chicken leg models under the microscope or loupes. Finally, the in-vivo rat exercises were intended for residents in the last 2 years who required access to the supplementary diploma in hand surgery. Outcome evaluations consisted of the Global Rating Scale score and time to completion. Two-tailed Student t test was performed to compare initial and final outcome evaluations (p<0.05). Only 8 residents completed the microvascular training of almost thirty microsurgical teaching sessions administered on a weekly basis. The total mean GRS score (and standard deviation) improved from 15±2 points for the initial score to 21±6 points for the final score (p<0.005). Time to completion of the anastomosis also significantly improved (p<0.005), from a mean score of 31:18±9:21 minutes for the initial time to 21:15±6:10 minutes for the final time. A microvascular training curriculum utilizing a live rat model, preceded by a training on non-living models, provides a superior surgical simulation experience and is effective at improving resident microvascular surgical skills.