Microsurgical training on non-living models: proposal for basic training

Microsurgery is an essential skill for plastic surgeons and a basic microsurgical course should be integrated into all plastic surgery residents' training programs, as mastering this technique cannot be reached only through observation and requires regular practice. Despite living models better simulate reality, non-living models have been shown to be valid tools for basic/intermediate microsurgical training. While many single preclinical exercises are described in the literature, there is lack of proposals for a complete basic program on non-living models. The aim of this study is to propose a basic microsurgical program entirely based on non-living models and to evaluate its feasibility with a cross-sectional study that analyses the outcomes of its application via the "Queen Mary University London microsurgery global rating scale" scoring system.

Nine different exercises for microsurgical training on non-living models were chosen based on a literature review. A basic step-by-step microsurgical training program was built. The program was proposed to the Plastic Surgery residents of our unit through a five-day training, during 2020-2023. No participants 'selection was made. All participants were examined with a practical test before and after the proposed program. The results of pre- and post-training test were collected and analysed.

Each trainee was able to complete a posterior-wall-first technique end-to-end anastomosis on the chicken thigh femoral artery with no major mistakes at the end of the program. Moreover, the data analysis revealed a statistically significant improvement of each evaluated skill after the training.

The proposed basic program is easy to organize and allows the trainee to develop the basic microsurgical skills needed to move to advanced training on living animals or on guided clinical practice.