MICROSURGICAL TECHNIQUE
A COURSE OF LABORATORY INSTRUCTION
Microsurgical Laboratory, Division of Plastic Surgery
The University of Mississippi Medical Center
Telephone: (601) 984 - 6882
Instructors:
Feng Zhang, M.D., Ph.D. ( email )
Wanda Dorsett-Martin, D.V.M. ( email )
Why learn microvascular
surgery? The answer is simple and basic: This technique enables us to improve
the quality of our surgical care of the acutely injured and the deformed.
Through
the microscope we can see more, therefore we can do more. This ten unit course
will provide surgical trainees with an opportunity to acquire a basic
orientation
to experimental and clinical microsurgery, and initiate a learning process to
develop superior microsurgical technique. The course consists of ten sessions,
each approximately four hours long.
Session 1: Practice
on silastic and tubing
Introduction to microsurgery
and laboratory procedures. Practice on a silastic glove and 1 mm tubing with
9-0 microsuture. Explanation of basic principles, instrument use, and body and
hand positions.
Session 2-3: Artery
end-to-end anastomosis
Step 1: Arterial end to
end anastomosis is performed by the instructor with the trainee assisting.
Subject
artery is rat femoral artery between the inguinal ligament and the superficial
epigastric branch, approximately 0.8 to 1 mm in diameter. 10-0 microsutures
are used. Basic aspects of anastomosis are discussed.
Step 2: Several arterial
anastomoses are performed by the trainee. In the introductory session, the
instructor
assists and guides the trainee to prevent formation of improper techniques which
may hinder future development and perfection. Upon completion trainee should
be well versed in the basic technique.
Session 4: Femoral vein
end to end anastomosis
Step 1: Venovenostomy by
the instructor with the trainee assisting. Discussion of difference between
arterial and venous anastomoses and particular problems associated with
venovenostomy.
The anastomosis of rat femoral vein (approximate 0.9 to 1.1 mm in diameter)
is performed with 10-0 suture.
Step 2: Venous anastomosis
by the trainee with the instructor observing, and if necessary, correcting
technique.
Session 5: Arterial
end to side anastomosis
Arterial end-to-side anastomosis
with the trainee assisting the instructor and then with the instructor assisting
the trainee. Discussion of technical differences between end-to-end anastomosis
and end-to-side anastomosis.
Session 6: Arteriovenous
anastomosis with arterial end to venous side
Arteriovenous anastomosis
with arterial end to venous side performed by the trainee with the instructor
assisting. Learning problems associated with joining vessels with different
wall thickness.
Session 7: Vein interposition
graft
Femoral vein interposition
graft to femoral vein and superficial epigastric vein interposition graft to
femoral artery are performed by the trainee with the instructor assisting. The
rat superficial epigastric vein is approximately 0.6 to 0.7 mm in diameter.
11-0 sutures are used. Discussion of vein grafting technique, indications and
complications.
Session 8: Sciatic nerve
epineural coaptation
Observation of sciatic
nerve epineural coaptation by the instructor with the trainee assisting.
Discussion
of methods of nerve coaptation (epifascicular epineural coaptation and
interfascicular
neural coaptation). Sciatic nerve epineural coaptation is performed by the
trainee
with the instructor assisting.
Session 9: Vascular
free graft (groin cutaneous flap)
Replantation of the groin
cutaneous free flap based on the superficial epigastric vessels in continuity
with the femoral vessels is performed by the trainee with the instructor
assisting.
Discussion of the cutaneous flap vascular anatomy associated with problems of
flap dissection. Flap survival examination at three days postoperatively.
Session 10: Vascular
free graft (latissmus dorsi muscular flap)
Transplantation of the
latissimus dorsi muscular free flap based on the thoracodorsal vessels is
performed
by the trainee with the instructor assisting. Discussion of the vascular
anatomy,
and advantages and disadvantages of the muscle flap compared with the cutaneous
free flap. basic science research before clinical application. We can develop cooperative
grants with various fields of surgical research.
We are developing the program
of complex wound management on flap designs for complex reconstruction,
transplantation
of limbs and skin, and models of surgical infection with ENT, neurosurgery,
oncology, transplantation, surgical infection, and breast surgery.
3. Microsurgery training
for multiple disciplines and OR personnel
The use of a microscope
enables surgical operations to advance from their originally macroscopic to
the microscopic sphere, and enables surgeons to improve the quality of surgical
care of the acutely injured and the deformed. Microsurgery training will provide
surgical trainees with an opportunity to acquire a basic orientation to
experimental
and clinical microsurgery, and initiate a learning process to develop superior
microsurgical technique in cardiovascular surgery, neurosurgery, urology,
obstetrics
and gynecology, and ENT surgery, and operating room personnel.
4. Cooperative administration
Cooperative administration
enables teaching, practice, and research to be integrated into a more effective,
practical, comprehensive, and well organized learning environment for the
trainees
and vehicle designed for the development of potential clinical applications
utilizing microsurgical techniques.
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